Endoscopic Submucosal Dissection Followed by Concurrent Chemoradiotherapy in Patients with Early Esophageal Cancer with a High Risk of Lymph Node Metastasis

Abstract

Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.

The influence of adjuvant radiation therapy after endoscopic resection on survival for early stage EC: an analysis of the surveillance epidemiology and end results (SEER) database

“…For early stage EC, the efficacy of ER followed by CRT has been evidenced by several studies (5,10,(15)(16)(17)(18)(19)(20). ER can remove or reduce the size of the tumor to reduce the risk of local recurrence.…”

“…ER followed by RT or CRT is a common combination treatment method for early stage ECs. It is effective for patients with early stage EC and has better or comparable efficacy with that of surgery or definitive CRT, as indicated by some retrospective studies (10,(15)(16)(17)(18)(19)(20). Addition of CRT aims to prevent lymph node recurrence, but there are very few studies validating the necessity of adjuvant CRT in this setting.…”

Unveiling Therapeutic Targets for Esophageal Cancer: A Comprehensive Review

“…Endoscopic resection or endoscopic treatment can be used to treat early EC (EEC) that is limited to the mucosa layer and has not spread to lymph nodes (LNM) [47]. Early EC refers to tumors confined to the mucosa or submucosa without lymphatic dissemination or distant metastases.…”

Editorial “Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer”

“…14 Wu et al recently expounded this work by presenting a model demonstrating great promise in facilitating individualized risk for lymph node metastasis in patients with T1 squamous cell carcinoma to establish candidacy for endoscopic resection. 16 Others appear to be following suit. 15 Suggestions that are more controversial have included the use of adjuvant concurrent chemoradiotherapy in patients determined to have a high risk of lymph node metastasis who undergo endoscopic submucosal dissection.…”

“…15 Suggestions that are more controversial have included the use of adjuvant concurrent chemoradiotherapy in patients determined to have a high risk of lymph node metastasis who undergo endoscopic submucosal dissection. 16 Additionally, the use of EMR as a diagnostic tool to better evaluate histologic features that might categorize the patient as high risk also has been proposed. 17 Interestingly, there has been little study regarding the utility of isolated lymph node sampling/dissection in patients thought to have high-risk features who undergo endoscopic resection.…”