Clin Endosc.  2015 Nov;48(6):553-557. 10.5946/ce.2015.48.6.553.

Endoscopic Submucosal Dissection for Recurrent or Residual Superficial Esophageal Cancer after Chemoradiotherapy: Two Cases

• Hwang C
• Youn YH
• Choi SE
• Jung YH
• Park HY
• Park JJ
• Kim JH
• Park H

• KMID: 2380415
• DOI: http://doi.org/10.5946/ce.2015.48.6.553

Abstract

We report two cases of endoscopic submucosal dissection (ESD) for recurrent or residual esophageal squamous cell carcinoma (ESCC) lesions after chemoradiotherapy for advanced esophageal cancer. Case 1 involved a 64-year-old man who had previously undergone chemoradiotherapy for advanced ESCC and achieved a complete response (CR) for 22 months, until metachronous recurrent superficial ESCC was detected on follow-up esophagogastroduodenoscopy (EGD). We performed ESD and found no evidence of recurrence for 24 months. Case 2 involved a 59-year-old man who had previously undergone chemoradiotherapy for advanced ESCC. He responded favorably to treatment, and most of the tumor had disappeared on follow-up EGD 4 months later. However, there were two residual superficial esophageal lugol-voiding lesions. We performed ESD, and he had a CR for 32 months thereafter. ESD can be considered a viable treatment option for recurrent or residual superficial ESCC after chemoradiotherapy for advanced esophageal cancer.

Keyword

Esophageal neoplasms; Chemoradiotherapy; Endoscopic submucosal dissection

MeSH Terms

Carcinoma, Squamous Cell
Chemoradiotherapy*
Endoscopy, Digestive System
Esophageal Neoplasms*
Follow-Up Studies
Humans
Middle Aged
Recurrence

Figure

• 

  Fig. 1. Initial esophagogastroduodenoscopy and positron emission tomography (PET) findings of case 1. (A) Esophageal mass lesion 24 cm from the incisors causing malignant stricture; the scope could not reach past the lesion. (B) PET image showing esophageal cancer at the mid to distal portion with paraesophageal invasion, including invasion of the subcarinal lymph node. (C) Image showing the radiation field.

• 

  Fig. 2. Esophagogastroduodenoscopy procedure and pathologic findings of case 1. (A, B) Salvage endoscopic submucosal dissection (ESD) for metachronous recurrent superficial esophageal squamous cell carcinoma. The lesion is 32 cm from the incisors and previously treated with radiation. (C) The pathologic finding of the ESD specimen showing a well-differentiated squamous cell carcinoma with lamina propria invasion. Ulceration with dilated vessels (white arrows), inflammatory infiltrates (black arrow), and mild fibrosis (arrowhead) in the lamina propria, so-called radiation change, are noted (H&E stain, ×200).

• 

  Fig. 3. Initial esophagogastroduodenoscopy (EGD) and positron emission tomography (PET) findings of case 2. (A) EGD image showing an esophageal ulcerofungating mass. (B) PET scan showing a large esophageal lesion 29 to 43 cm from the incisors and metastasis to the left supraclavicular lymph node (white arrows). (C) Image showing the radiation field.

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  Fig. 4. Esophagogastroduodenoscopy procedure and pathologic finding of case 2. (A, B) Endoscopic submucosal dissection (ESD) en bloc resection of the residual superficial lugol-voiding lesion 38 cm from the incisors. (C) The pathologic finding of the ESD specimen showing a well-differentiated squamous cell carcinoma with lamina propria invasion. Dilated vessels (white arrow), inflammatory infiltrates (black arrow), and mild fibrosis (arrowhead) in the lamina propria are shown (H&E stain, ×200).

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