Successful salvage endoscopic mucosal resection for residual superficial hypopharyngeal carcinoma after chemoradiotherapy, with long-term survival

Abstract

We have read with great interest the article by Yano et al. [1] on the utility of salvage endoscopic mucosal resection (EMR) in esophageal carcinoma patients with local failure after definitive chemoradiotherapy, and also the article by Iizuka et al. [2] on the safety of endoscopic submucosal dissection (ESD) and the efficacy of elevation of the larynx for treatment of early mesopharyngeal and hypopharyngeal carcinoma. Yano and colleagues reported that 5-year survival rates following salvage EMR were 67.5 % (T1, n = 11) and 30.0 % (T3/T4, n = 10). Their data show that salvage EMR is not inferior to salvage esophagectomy for recurrent or residual esophageal carcinoma after definitive chemoradiotherapy [3], in terms of curative treatment effect and long-term survival, if the lesions are superficial without lymph node and distant metastasis. Iizuka and colleagues attempted ESD with elevation of the larynx with the objective of improving the efficiency and effectiveness of endoscopic treatment for pharyngeal lesions. In order to perform this technique with adequate intraoperative and postoperative management and without serious complications, cooperation between endoscopists and otolaryngologists is necessary. We have also always performed treatment in cooperation with otolaryngologists for cases of early-stage head and neck cancer. Patients with primary superficial laryngopharyngeal carcinoma at an early stage have been curatively treated by EMR and ESD with such cooperation, especially in Japan [2] [4] [5] [6]. However, the utility of salvage EMR or ESD for residual superficial laryngopharyngeal carcinoma after definitive chemoradiotherapy is unclear. Here we describe for the first time a case of long-term survival following successful treatment with salvage EMR for residual superficial hypopharyngeal carcinoma after definitive chemoradiotherapy, in cooperation with otolaryngologists, and we discuss the utility of salvage EMR in this context.