Treatment Strategy for Esophageal Squamous Cell Carcinoma With Endoscopic Intramural Metastasis.

Akihiko Okamura,Jun Kanamori,Mariko Ogura,Junko Fujisaki,Toshiyuki Yoshio,Keisho Chin,Yu Imamura,Takao Asari,Shoichi Yoshimizu,Izuma Nakayama,Akiyoshi Ishiyama,Masayuki Watanabe

doi:10.7759/cureus.23028

Abstract

Purpose: Intramural metastasis (IM) in esophageal squamous cell carcinoma (ESCC) is sometimes found, and the prognosis of ESCC patients with pathologically diagnosed IM is known to be dismal. However, there are few reports on ESCC patients with clinically diagnosed IM.Methods: This study assessed 2,772 ESCC patients who underwent endoscopy for initial evaluation. Among them, 85 patients (3.1%) were diagnosed with endoscopic IM. In this study, we investigated these patients’ characteristics, survival among the groups stratified by the treatment modalities, and survival predictors.Results: Of 85 patients, 76 (89.4%) had T3 or T4 tumors, 73 (85.9%) had nodal metastases, and 36 (42.4%) had M1 diseases. Curative-intent treatment could be given to 63 patients (74.1%) with a median survival time (MST) of 15.6 months (95% CI: 10.7-20.4). As initial treatment, upfront surgery (US), neoadjuvant chemotherapy (NAC) using cisplatin and 5-fluorouracil (CF), neoadjuvant chemoradiotherapy, and definitive chemoradiotherapy (dCRT) were given to 17 (27.0%), 27 (42.9%), 2 (3.2%), and 17 patients (27.0%), respectively. dCRT was preferred for T4 tumors compared with US or NAC (P = 0.02). The MST of US and NAC patients was 19.3 (95% CI: 12.9-25.6) and 23.4 months (95% CI: 9.4-37.4), respectively. No significant difference was noted between US and NAC patients (P= 0.89).Conclusion: The prognosis of ESCC patients with endoscopic IM is poor even if curative-intent treatment is done. Moreover, no significant survival benefit of NAC with CF for these patients was observed when compared with US.

Highlights

Diagnosed intramural metastasis (IM) of esophageal squamous cell carcinoma (ESCC) is sometimes found with an incidence rate of 5.5-16.6%, and the prognosis of these patients was suggested to be dismal [1-7]
Hokamura et al evaluated the efficacy of neoadjuvant chemotherapy (NAC) that consisted of cisplatin and 5fluorouracil (CF) for ESCC with IM diagnosed by endoscopy [8]
upfront surgery (US), NAC, neoadjuvant chemoradiotherapy (NACRT), and definitive chemoradiotherapy (dCRT) were chosen as the initial treatment for 17 (27.0%), 27 (42.9%), 2 (3.2%), and 17 patients (27.0%), respectively. dCRT was more frequently selected for T4 tumors, compared with US or NAC (P = 0.02, Table 2)

Summary

Introduction

Diagnosed intramural metastasis (IM) of esophageal squamous cell carcinoma (ESCC) is sometimes found with an incidence rate of 5.5-16.6%, and the prognosis of these patients was suggested to be dismal [1-7]. Pathological IM has shown to be an indicator of lymphatic invasion and advanced cancer in ESCC patients [7]. Previous reports on IM were mainly on its pathological diagnosis after surgery [1-7], and few on the clinical features of ESCC patients with clinically diagnosed IM by endoscopy. Half of the pathological IM cases were identified during preoperative examination [6,7], and the characteristics and outcomes of ESCC patients with clinically diagnosed IM remain unknown. Hokamura et al evaluated the efficacy of neoadjuvant chemotherapy (NAC) that consisted of cisplatin and 5fluorouracil (CF) for ESCC with IM diagnosed by endoscopy [8]. They reported no NAC survival benefit when compared with their historical data. This study conducted a small-sample single-arm trial, with only 15 patients

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