3536 High-grade dysplasia and superficial squamous cell cancer off the esophagus: differential endoscopic therapy.

Abstract

So far esophagectomy is the treatment of choice for high-grade dysplasia (HGD) and early cancer (EC) of the esophagus. New, minimally invasive treatment modalities, such as photodynamic therapy (PDT) and endoscopic mucosal resection (EMR) are local endoscopic therapeutic options which might offer a successful treatment of early malignancies without the risks of esophagectomy. Methods: Between 3/95 and 10/99 94 patients (15 females and 79 males, mean age: 62.3 years) with histologically proven HGD (n=9) and EC (n=85) were referred for further diagnosis and therapy. 28 patients with more advanced tumors after staging (infiltration of the submucosa: uT1sm; and uT2) were excluded from the study. In curative intention 64 patients were treated according to their tumor size with EMR (n=15) or PDT(n=49). Results: In 9/9 patients with HGD a complete remission was observed (100%). Overall 34/55 patients (62%) with EC (EMR: 11/15 pats; PDT: 23/40 pats) showed an initial complete response after an average of 2.9 treatments with a follow-up of 1 48 months. Small focal lesions (size < 3 cm, penetrationn depth < 2 mm and macroscopic tumor type I, IIa, IIb) turned out to be low-risk-cancer, in 11/12 patients a complete remission could be induced. Conclusions: High-grade dysplasia and low-risk early cancers of the esophagus were successfully treated in >90 % of cases. EMR is the treatment of choice for small, localized lesions while PDT is the best treatment modality for multifocal and superficially spreading, large HGD and EC. So far esophagectomy is the treatment of choice for high-grade dysplasia (HGD) and early cancer (EC) of the esophagus. New, minimally invasive treatment modalities, such as photodynamic therapy (PDT) and endoscopic mucosal resection (EMR) are local endoscopic therapeutic options which might offer a successful treatment of early malignancies without the risks of esophagectomy. Methods: Between 3/95 and 10/99 94 patients (15 females and 79 males, mean age: 62.3 years) with histologically proven HGD (n=9) and EC (n=85) were referred for further diagnosis and therapy. 28 patients with more advanced tumors after staging (infiltration of the submucosa: uT1sm; and uT2) were excluded from the study. In curative intention 64 patients were treated according to their tumor size with EMR (n=15) or PDT(n=49). Results: In 9/9 patients with HGD a complete remission was observed (100%). Overall 34/55 patients (62%) with EC (EMR: 11/15 pats; PDT: 23/40 pats) showed an initial complete response after an average of 2.9 treatments with a follow-up of 1 48 months. Small focal lesions (size < 3 cm, penetrationn depth < 2 mm and macroscopic tumor type I, IIa, IIb) turned out to be low-risk-cancer, in 11/12 patients a complete remission could be induced. Conclusions: High-grade dysplasia and low-risk early cancers of the esophagus were successfully treated in >90 % of cases. EMR is the treatment of choice for small, localized lesions while PDT is the best treatment modality for multifocal and superficially spreading, large HGD and EC.