Endoscopic Management of Esophageal Cancer After Definitive Chemoradiotherapy

Khangura, Sajneet; Greenwald, Bruce D.

doi:10.1007/s10620-012-2554-0

“…Other treatment methods for post-CRT lesions besides ESD include photodynamic therapy (PDT) 29 and ablation 30 , which are reported to be effective. Khangura et al 30 conducted a meta-analysis of the endoscopic treatments for post-CRT recurrence or residual lesions, including PDT, EMR, and spray cryotherapy, and reported that any of these methods may be effective for cases in which surgery is not an option. However, as in this report, the number of clinical cases was not enough.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy

Kagawa

¹

,

Ishikawa

²

,

Inaba

³

et al. 2018

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Background and study aims Salvage therapy for esophageal cancer following chemo-radiation therapy (CRT) has not been established. We aimed to evaluate endoscopic submucosal dissection (ESD) as a salvage therapy based on histopathological features of lesions. Patients and methods We compared 10 lesions in eight patients with local residual, recurrent, or metachronous esophageal squamous cell carcinoma treated by ESD after CRT (CRT group) and 59 lesions treated by ESD without CRT (non-CRT group) during the same period. Results The en bloc resection rate was 100 % while the complete resection rate was 80.0 % in the lesions after CRT, indicating no difference between the CRT and non-CRT groups. Pathological examination showed that fibrosis was more intense in the lamina propria mucosa, muscularis mucosa, and submucosa. The muscularis mucosa was thicker in both non-tumor and tumor sites in the CRT group compared to the non-CRT group. However, severe submucosal fibrosis was observed only in one lesion in the CRT group. The maximum diameter of the submucosal artery was significantly larger in the CRT group ( P < 0.001). Conclusions Compared to the non-CRT group, the lesions in the CRT group were accompanied by fibrosis while the muscularis mucosa were thicker; however, severe fibrosis of the submucosa was rare. It is important to dissect the muscularis mucosa appropriately during ESD, which makes successful dissection of the submucosa possible. Attention should be paid to bleeding from large arteries.

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“…A significant factor in improving survival after chemoradiation involves local disease control. 1 The present case demonstrates the long-term safety and efficacy of adjunctive cryoablation in combination with concurrent chemoradiotherapy for local control of recurrent esophageal cancer. Over the treat-ment course, the primary tumor increased slowly in length; however, chemo-cryo-radiotherapy appeared to maintain disease control.…”

Section: Discussionmentioning

confidence: 59%

“…Despite the increasing success of chemoradiation in inducing remission in esophageal cancer, the rate of recurrent disease remains as high as 60%. 1 Endoscopic cryotherapy is a novel ablative treatment that involves cycles of rapid freezing and thawing. This technique destroys tissues via ischemic mechanisms of vascular stasis, endothelial damage, and vascular thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Long-term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation

Spiritos

¹

,

Mekaroonkamol

²

,

Willingham

³

et al. 2016

American Journal of Gastroenterology

0

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Esophageal cancer has a poor overall prognosis and is frequently diagnosed at a late stage. Conventional treatment for metastatic esophageal cancer involves chemotherapy and radiation. Local disease control plays a significant role in improving survival. Endoscopic spray cryotherapy is a novel modality that involves freezing and thawing to produce local ablation of malignant tissue via ischemic mechanisms. Spray cryotherapy has been shown to be effective, particularly for early T-stage, superficial esophageal adenocarcinomas. We present the case of a 72-year-old-male with locally recurrent stage IV esophageal adenocarcinoma and long-term survival of 7 years to date, with concurrent chemoradiation and serial cryoablation. He remains asymptomatic and continues to undergo chemotherapy and sequential cryoablation. The findings highlight the long-term safety and efficacy of cryotherapy in combination with chemoradiation, and suggest that cryoablation may have an additive role in the treatment of advanced stage esophageal adenocarcinoma.

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“…Following diagnosis, many patients suffer significant comorbidities and require interventions such as esophageal stenting and feeding tube placement. A significant factor in improving survival after chemoradiation involves local disease control [ 1 ]. The present case demonstrates the long-term safety and efficacy of adjunctive cryoablation in combination with concurrent chemoradiotherapy for local control of recurrent esophageal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increasing success of chemoradiation in inducing remission in esophageal cancer, the rate of recurrent disease remains as high as 60% [ 1 ]. Endoscopic cryotherapy is a novel ablative treatment that involves cycles of rapid freezing and thawing.…”

Section: Introductionmentioning

confidence: 99%

Long -Term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation

Spiritos

¹

,

Mekaroonkamol

²

,

El‐Rayes

³

et al. 2017

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Esophageal cancer has a poor overall prognosis and is frequently diagnosed at a late stage. Conventional treatment for metastatic esophageal cancer involves chemotherapy and radiation. Local disease control plays a significant role in improving survival. Endoscopic spray cryotherapy is a novel modality that involves freezing and thawing to produce local ablation of malignant tissue via ischemic mechanisms. Spray cryotherapy has been shown to be effective, particularly for early T-stage, superficial esophageal adenocarcinomas. We present the case of a 72-year-old-male with locally recurrent stage IV esophageal adenocarcinoma and long-term survival of 7 years to date, with concurrent chemoradiation and serial cryoablation. He remains asymptomatic and continues to undergo chemotherapy and sequential cryoablation. The findings highlight the long-term safety and efficacy of cryotherapy in combination with chemoradiation, and suggest that cryoablation may have an additive role in the treatment of advanced stage esophageal adenocarcinoma.

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Endoscopic Management of Esophageal Cancer After Definitive Chemoradiotherapy

Cited by 16 publications

References 60 publications

Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy

Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy

Long-term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation

Long -Term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation

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