Long-term results of salvage endoscopic mucosal resection in patients with local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma

Background and study aims: Local failure after definitive chemoradiotherapy (CRT) in patients with esophageal cancer remains one of the major problems in finding a cure. Endoscopic mucosal resection (EMR) is one treatment option when failure lesions are superficial. However, there are no relevant long-term survival data. The aim of this study was to clarify the long-term survival of salvage EMR.

Patients and methods: Between January 1998 and March 2004, 289 patients with esophageal squamous cell carcinoma were treated with definitive CRT at the National Cancer Center Hospital East, Japan. Of these 289 patients, 21 patients with local failure without lymph-node or distant metastases were treated with salvage EMR. The technique of salvage EMR involved a strip biopsy method. We retrospectively analyzed the long-term survival data for the patients who underwent salvage EMR.

Results: At a median follow-up period of 54 months (range, 16 – 108 months), eight of 21 patients (38 %) were alive with no recurrence and two patients had died from another disease but with no recurrence of esophageal cancer. Local recurrence after EMR was detected in four patients, with local and lymph-node recurrence in two patients, and lymph-node and/or distant metastases in five patients. The 5-year survival rate from the initiation of salvage EMR was 49.1 %. There were no severe complications associated with EMR.

Conclusion: EMR is one of the curative salvage treatment options for local failure after definitive CRT, if the failure lesion is superficial and there are no lymph-node or distant metastases.

References

• 1 Swisher S G, Wynn P, Putnam J B. et al . Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy.  J Thorac Cardiovasc Surg. 2002;  123 173-183
• 2 Hattori S, Muto M, Ohtsu A. et al . EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer.  Gastrointest Endosc. 2003;  58 65-70
• 3 UICC (International Union Against Cancer) .TNM classification of malignant tumors. 5th edn. New York; Wiley-Liss 1997
• 4 Tahara M, Ohtsu A, Hironaka S. et al . Clinical impact of criteria for complete response (CR) of primary site to treatment of esophageal cancer.  Jpn J Clin Oncol. 2005;  35 316-323
• 5 Momma K, Sakaki N, Yoshida M. Endoscopic mucosectomy for precise evaluation and treatment of esophageal intraepithelial cancer.  Endosc Dig. 1990;  2 501-506
• 6 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer.  Endoscopy. 1993;  25 445-450
• 7 Herskovic A, Martz K, Al-Sarraf M. et al . Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of esophagus.  N Engl J Med. 1992;  326 1593-1598
• 8 Hironaka S, Ohtsu A, Boku N. et al . Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2–3)N(any)M(0) squamous cell carcinoma of the esophagus.  Int J Radiat Oncol Biol Phys. 2003;  57 425-433
• 9 Ishikura S, Nihei K, Ohtsu A. et al . Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus.  J Clin Oncol. 2002;  21 2697-2702
• 10 Minsky B D, Pajak T F, Ginsberg R J. et al . INT 0123 (Radiation Therapy Oncology Group 94 – 05) phase III trial of combined modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy.  J Clin Oncol. 2002;  20 1167-1174
• 11 Meunier B, Raoul J, LePrise E. et al . Salvage esophagectomy after unsuccessful curative chemoradiotherapy for squamous cell cancer of the esophagus.  Dig Surg. 1998;  15 224-226
• 12 Shimizu Y, Kato M, Yamamoto J. et al . Endoscopic clip application for closure of esophageal perforations caused by EMR.  Gastrointest Endosc. 2004;  60 636-639
• 13 Yano T, Muto M, Minashi K. et al . Photodynamic therapy as salvage treatment for local failures after definitive chemoradiotherapy for esophageal cancer.  Gastrointest Endosc. 2005;  62 31-36