Endoscopic Mucosal Resection Combined with Chemoradiotherapy for Superficial Esophageal Squamous Cell Carcinoma

Abstract

Listen

Translate article

Background: Esophagectomy with lymph node dissection is the procedure of choice for patients with superficial esophageal squamous cell carcinomas (T1; TNM classification 1997) invading the muscularis mucosae or deeper. However, esophagectomy is very invasive and associated with increased morbidity and mortality. Another choice of treatment for patients with superficial esophageal carcinoma is chemoradiotherapy (CRT). Many authors have reported the effectiveness of CRT for patients with esophageal squamous cell carcinoma. Nevertheless, local failure often occurs in patients who have undergone CRT, and local tumor control remains the biggest problem. We have conducted a novel treatment, endoscopic mucosal resection (EMR) combined with CRT for patients with superficial esophageal carcinoma. EMR was carried out for the purpose of complete local tumor control, and CRT was carried out for the purpose of regional and distant control. Methods: We performed EMR combined with CRT for patients with esophageal carcinomas invading the muscularis mucosae or upper submucosa who refused to undergo esophagectomy. After complete resection of tumors and histological confirmation of the depth of tumor invasion, adjuvant CRT was started. Planned treatment after EMR was 40 to 46 Gy of external beam radiation to the mediastinum, including the supraclavicular fossa or cardia. Chemotherapy was given during Weeks 1 and 5, with 5-FU 700 mg/m2 /24 hours in a 120-hour infusion and cisplatin 15 mg/m2 /day on days 1 to 5. Results: During the study period, 16 patients underwent EMR combined with CRT (EMR plus CRT group) and 39 patients in a similar stage underwent esophagectomy (surgical resection group). No severe complications occurred in patients in the EMR plus CRT group. None of the patients in the EMR plus CRT group have had local recurrence or metastasis. Overall survival rates at 5 years in the EMR plus CRT group and surgical resection group were estimated to be 100% and 87.5%, respectively. The cause-specific survival rates at 5 years in the extended EMR group and surgical resection group were 100% and 90.7%, respectively. Conclusions: Although not randomized, the results of this study suggests that EMR combined with CRT is a safe and effective method for treating for patients with superficial esophageal carcinoma, the results of which are equivalent or, in view of the lower degree of invasiveness, superior to surgical resection.