Combination of endoscopic mucosal resection and chemoradiotherapy as a nonsurgical treatments for patients with clinical stage I esophageal squamous cell carcinoma

Abstract

4529 Background: Endoscopic mucosal resection (EMR) has become the standard treatment for mucosal cancer. For the other clinical stage I esophageal squamous cell carcinoma (ESCC), radical surgery is standard and chemoradiotherapy (CRT) is optional but has high locoreginoal failure. If EMR and CRT are combined efficiently, these may improve outcomes with less invasion. A retrospective analysis was conducted to evaluate the efficacy of these combined nonsurgical modalities. Methods: Recruitment criteria were histologically proven SCC, clinically estimated as stage I except for the candidates of the standard EMR, age ≤ 75, PS ≤ 2, no prior therapy, no serious complication and no other active malignancy. Primary EMR was indicated if a tumor was within the focal submucosal (SM) invasion and a width of less than two-thirds of its circumference. EMR was followed by prophylactic CRT (5-FU + cisplatin + RT; 40Gy) for latent node metastasis when SM invasion was present pathologically. The remaining patients (pts) underwent primary CRT (5-FU + cisplatin + RT; 60Gy); salvage EMR was indicated for local residual, recurrent, or metachronous tumors. Results: Between Jan. 1996 and Apr. 2004, 86 pts fulfilled the criteria; median age 60 years (46–75), male/female; 74/12. Forty-one received primary EMR and 45 received primary CRT. Pathological diagnoses of primary EMR revealed eight mucosal cancers of the epithelium and lamina propria, 19 of the musclaris mucosae (MM), and 14 SM cancers. Eleven pts with SM cancers subsequently underwent prophylactic CRT, one with SM cancer underwent surgery, and the remaining 29 pts with mucosal and MM cancers received no additional treatment. Of the 45 CRT pts, 11 (24%) received salvage EMR. Three (3%) (one primary EMR pt and two primary CRT pts) underwent salvage surgery. With a median follow-up of 4.2 years, the 4-year overall survival of all, primary EMR, and primary CRT pts was 76%, 78%, and 72%, respectively; the disease-specific survival was 86%, 91%, and 81%, respectively. Conclusion: The survival of combination treatment with EMR and CRT for clinical stage I ESCC was comparable with that of surgery in Japan. EMR and/or CRT may be highly effective, minimally invasive treatments for stage I ESCC. No significant financial relationships to disclose.