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Open Access 01-12-2015 | Research

The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer

Authors: Gen Kawaguchi, Ryuta Sasamoto, Eisuke Abe, Atsushi Ohta, Hiraku Sato, Kensuke Tanaka, Katsuya Maruyama, Motoki Kaizu, Fumio Ayukawa, Nobuko Yamana, Junyang Liu, Manabu Takeuchi, Masaaki Kobayashi, Hidefumi Aoyama

Published in: Radiation Oncology | Issue 1/2015

Abstract

Background

To evaluate the risks and benefits of endoscopic submucosal dissection (ESD) in addition to chemoradiotherapy (CRT) for the treatment of superficial esophageal squamous cell carcinoma (SESCC).

Methods and materials

We retrospectively reviewed the treatment outcomes of 47 patients with SESCC treated between October 2000 and December 2011. Sixteen patients with invasion into the submucosal layer (T1b) or the muscularis mucosa (m3) with positive vascular invasion were treated with CRT after ESD (ESD-CRT group). The lymph node area was irradiated to a total dose of 40–44 Gy and a boost radiation was administered if PET-positive lymph nodes or positive margins were observed. The remaining 31 patients received definitive CRT only (dCRT group).

Results

The radiation field was significantly larger in the ESD-CRT group; the “long T” was used in 11 patients (35.4%) in the dCRT group and 15 (93.7%) in the ESD-CRT group (p = 0.0001). The total radiation dose was smaller in the ESD-CRT group; 40 Gy was used in 10 patients (62.5%) in the ESD-CRT group and all but one patient in the dCRT group received ≥60 Gy (p = 0.00001). The 3-year overall survival rates in the dCRT and ESD-CRT groups were 63.2% and 90.0% respectively (p = 0.118). Recurrence developed in nine patients (29.0%) in the dCRT group and one (6.3%) in the ESD-CRT group. Local recurrence was observed in six patients (19%) in the dCRT group and none in the ESD-CRT-group (p = 0.029). Pericardial effusion (≥Grade 3) occurred in three patients (9.7%) in the dCRT group and none in the ESD-CRT group.

Conclusions

ESD followed by CRT is an effective and safe approach for SESCC at m3 or T1b. This combination of ESD and CRT improves the local control rate, and it could decrease the number of cardiac toxicities due to a radiation-dose reduction relative to CRT alone.

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Title: The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer
Authors: Gen Kawaguchi
Ryuta Sasamoto
Eisuke Abe
Atsushi Ohta
Hiraku Sato
Kensuke Tanaka
Katsuya Maruyama
Motoki Kaizu
Fumio Ayukawa
Nobuko Yamana
Junyang Liu
Manabu Takeuchi
Masaaki Kobayashi
Hidefumi Aoyama
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-015-0337-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer

Abstract

Background

Methods and materials

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods and materials

Results

Conclusions

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