Abstract
BackgroundEndoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for superficial esophageal cancer involving the muscularis mucosae (T1a-MM) or upper third of the submucosa (T1b-SM1). Additional treatment after ESD is needed to prevent lymph node metastasis. However, the efficacy of radiotherapy following ESD has not been well evaluated. Moreover, the clinical outcomes of patients with large mucosal defects of the esophagus who received radiotherapy after ESD have not been reported. This study aimed to clarify the efficacy of additional radiotherapy following ESD for esophageal squamous cell cancer involving T1a-MM or T1b-SM1.MethodsWe analyzed twenty-seven patients with pathologically confirmed T1a-MM or T1b-SM1 esophageal squamous cell cancer treated by ESD. Thirteen patients received additional radiotherapy (RT group), and the remaining patients did not (non-RT group). Locoregional control (LRC), overall survival, cause-specific survival, and adverse events including treatment-related esophageal strictures were evaluated.ResultsThe three-year LRC was significantly better for the RT than the non-RT group (100% vs. 57.8%, respectively; p = 0.022). Chemotherapy following ESD did not improve LRC. Multivariate analysis showed that radiotherapy was an independent prognostic factor for better LRC (p = 0.0022). Contrary to the results in LRC, overall and cause-specific survival were not significantly different between the RT and non-RT groups. A subgroup analysis of patients with mucosal defects involving ≥ 3/4 of the esophageal circumference after ESD showed that LRC of the RT group was better than that of the non-RT group (p = 0.049). Treatment-related esophageal strictures were observed in 2 of 6 patients in the RT group with large mucosal defects after ESD. No patients with mucosal defects involving less than 3/4 of the circumference after ESD developed treatment-related strictures.ConclusionsRadiotherapy after ESD contributed to better LRC in esophageal squamous cell cancer involving pT1a-MM and pT1b-SM1. Esophageal strictures were observed in some patients with large mucosal defects after ESD. Despite leading to better LRC, radiotherapy after ESD should be undertaken after careful consideration for patients with large mucosal defects after ESD.
Highlights
Endoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for superficial esophageal cancer involving the muscularis mucosae (T1a-MM) or upper third of the submucosa (T1b-SM1)
Patient characteristics Twenty-seven patients with pT1a-MM or pT1b-SM1 esophageal squamous cell cancer (ESCC) were divided into 2 groups
Our findings indicate that additional RT was significantly associated with better Locoregional control (LRC) but not with survival in patients with pT1a-MM or pT1bSM1 ESCC treated with ESD
Summary
Endoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for superficial esophageal cancer involving the muscularis mucosae (T1a-MM) or upper third of the submucosa (T1b-SM1). ESD for ESCC involving T1a-MM or T1b-SM1 is performed as a diagnostic resection or for inoperable patients This technique is usually performed for lesions occupying less than three-quarters of the circumference of the esophagus, because the incidence of esophageal stricture after ESD is low [5]. Considering the incidence of lymph node metastases in ESCC involving pT1a-MM or pT1b-SM1, additional treatment is needed after ESD to prevent lymph node metastasis [4]. A few studies have reported the efficacy of additional radiotherapy (RT) performed after endoscopic resection for ESCC involving pT1a-MM or pT1b-SM1 [6,7,8].
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