Clin Endosc.  2019 Sep;52(5):502-505. 10.5946/ce.2018.176.

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

• Kim HK
• Ko WJ
• Kwon CI
• Song GW
• Yoo IK
• Song JH
• Kim HS
• Cho JY

• KMID: 2464673
• DOI: http://doi.org/10.5946/ce.2018.176

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.

Keyword

Early esophageal cancer; Concurrent chemoradiotherapy; Endoscopic submucosal dissection

MeSH Terms

Chemoradiotherapy*
Esophageal Neoplasms*
Follow-Up Studies
Humans
Lymph Nodes*
Neoplasm Metastasis*
Prospective Studies
Recurrence
Survival Rate

Figure

• 

  Fig. 1. (A) A flat elevated mucosal lesion, 2.5–3.0 cm in size and located 20–23 cm from the upper incisor, was detected during an esophagogastroduodenoscopy; (B) Magnification endoscopy revealed dilatation and irregular caliber changes of the intrapapillary capillary loop (IPCL-V1); (C) ESD was performed based on the biopsy results that suggested the presence of squamous cell carcinoma; (D) The specimen was 22×13 mm in size.

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  Fig. 2. Cancer-invaded submucosal layer of Patients 2 and 5 are shown in panels (A) and (B), respectively.

Reference

1. Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013; 381:400–412.

2. Stilidi I, Davydov M, Bokhyan V, Suleymanov E. Subtotal esophagectomy with extended 2-field lymph node dissection for thoracic esophageal cancer. Eur J Cardiothorac Surg. 2003; 23:415–420.

3. Saeki H, Watanabe M, Mine S, et al. Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection. J Gastroenterol. 2015; 50:406–413.

4. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005; 23:2310–2317.

5. Bedenne L, Michel P, Bouché O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007; 25:1160–1168.

6. Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005; 3(7 Suppl 1):S67–S70.

7. Park HC, Kim DH, Gong EJ, et al. Ten-year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center. Korean J Intern Med. 2016; 31:1064–1072.

8. Crosby T, Evans M, Gillies RS, Maynard ND. The management of a patient with an operable carcinoma of the oesophagus. Ann R Coll Surg Engl. 2009; 91:366–370.

9. Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol. 2015; 10:31.