Local efficacy and survival outcome of salvage endoscopic therapy for local recurrent lesions after definitive chemoradiotherapy for esophageal cancer

Abstract

BackgroundSalvage endoscopic therapy (SET), such as endoscopic mucosal resection (EMR) and photodynamic therapy (PDT), is a less-invasive treatment for local failure at the primary site after chemoradiotherapy (CRT) for esophageal squamous cell carcinoma (ESCC). We conducted this retrospective study to clarify the risk factors for local recurrence along with the long term results after SET for recurrent lesions after definitive CRT for ESCC.MethodsWe enrolled 77 consecutive patients who underwent EMR or PDT for local recurrence without any metastasis after definitive CRT at our institution. We evaluated the local efficacy, local recurrence-free survival (LRFS), and overall survival (OS), and investigated the risk factors associated with survival outcome using a multivariate analysis.ResultsThe complete resection rate of EMR was 84.6 % (33/39), and the complete response rate for PDT was 65.8 % (25/38). Twenty-two patients (28.6 %) exhibited local recurrence without metastasis. Thirty-four patients (44.2 %) were alive at 5 years after undergoing only initial SET or with repeated SET. The 5-year LRFS rate was 59.6 %, and the presence of lesions occupying an esophageal circumference of 1/4 or larger was the only significant risk factor (HR: 3.10, 95 % CI: 1.35–7.15, P = 0.008). The 5-year OS rate was 48.4 %, and an advanced T factor before CRT was marginally associated with a poor OS (HR: 1.96, 95 % CI: 0.98–3.92, P = 0.055).ConclusionsSET enabled a preferable local control and survival outcome for patients with local recurrence after definitive CRT for ESCC. Careful endoscopic follow-up is needed for patients with a large lesion before SET and those with an advanced T factor before CRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0604-z) contains supplementary material, which is available to authorized users.

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

“…Thus, due to unexpected outcomes, controversy exists regarding salvage therapy. There are few reports on endoscopic submucosal dissection (ESD) 10 11 12 despite many reports describing endoscopic mucosal resection (EMR) 13 14 15 . Locoregional failure or a metachronous lesion after CRT may be accompanied by tissue fibrosis 10 11 16 , which may cause difficulty in performing ESD and may lead to accidental perforation or massive bleeding during the procedure.…”

Management of pathologic node-positive disease following initial surgery for clinical T1-2 N0 esophageal cancer: patterns of care and outcomes from the national cancer data base

“…First, it is clear that the elderly may suffer greater toxicities with adjuvant therapy, and clinical hesitation may hence give way to a "watchful waiting" approach to treat only if recurrent disease develops. As such, there are several reports delineating the safety and efficacy of salvage therapies following local/locoregional recurrences of EC, although predictably the cT1-2N0 cohort is underrepresented [20][21][22]. Second, similar to other thoracic neoplasms [23], there are data showing that the presence of limited/minimal nodal involvement on complete nodal dissection may provide satisfactory outcomes in cT1-2N0 disease, without specific necessity to perform routine adjuvant therapy [24,25].…”

Salvage endoscopic resection in patients with esophageal adenocarcinoma after chemoradiotherapy

“…In case series from Japan, salvage endoscopic resection of residual cancer after definitive CRT has been reported in esophageal squamous cell carcinoma 3 4 5 . Yano et al reported a local failure rate of 34 % in patients treated with definitive CRT after diagnosis of squamous cell carcinoma of the esophagus.…”

“…Yano et al reported a local failure rate of 34 % in patients treated with definitive CRT after diagnosis of squamous cell carcinoma of the esophagus. Because of the high local recurrence rate for squamous cell carcinomas, curative local control is crucial and salvage endoscopic resection provides a therapeutic option with curative intent 3 5 . Reports of curative treatment with salvage endoscopic resection of recurrent or residual squamous cell carcinoma after definitive CRT have been described, however to date, curative treatment with salvage endoscopic resection in cases of residual adenocarcinoma after CRT has not been reported.…”