Salvage Endoscopy Viable for Some Esophageal Cancers

January 29, 2014

By Bridgett Novak

NEW YORK (Reuters Health) Jan 29 - Salvage endoscopic treatment is a viable option for patients with local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma (ESCC), researchers said January 17 at the 2014 Gastrointestinal Cancers Symposium in San Francisco.

Local failure is a major problem after chemoradiotherapy (CRT) for ESCC, but traditional salvage surgery has high morbidity and mortality. Salvage endoscopic treatment (SET) - i.e., photodynamic therapy (PDT) or endoscopic resection (ER) -- has been recommended as a less invasive treatment.

For the current study, the research team reviewed data on 716 ESCC patients who were treated with CRT. The majority had Stage II (followed closely by Stage III) and T1 cancers. Of the 417 patients who suffered local failure (either an incomplete response or local recurrence), 164 underwent SET. ER was performed for local failures limited to T1b (SM1). PDT was performed on lesions invading T1b (SM2) or T2, or if the patient could not tolerate or refused surgery.

ER achieved curative resection in 88% of the patients; PDT achieved complete response in 57.5%. At five years, the overall survival (OS) and relapse-free survival (RFS) rates were 38.6% and 28%, and 58 patients (35.4%) were alive without any metastasis under esophagus preservation.

The two factors that contributed most to improved OS and RFS were the absence of lymph node metastasis before chemoradiotherapy and allowing six months or more between initiation of chemoradiotherapy and SET.

"Carefully selected patients with local failure after chemoradiotherapy can achieve successful efficacy with local endoscopic treatment," lead researcher Dr. Ken Hatogai from the the National Cancer Center Hospital East in Kashiwa City, Japan, told Reuters Health by email. "We also learned that regardless of salvage treatment, it is important to consider initial extension of the disease before chemoradiotherapy as well as its clinical course after CRT."

"This study indicates that salvage endoscopy is a non-invasive and effective treatment for ESCC patients who have residual or recurrent cases of smaller tumor burden and that it has promising long-term results," observed Dr. Kei Muro, Director & Chief, Department of Clinical Oncology and the Outpatient Treatment Center at Aichi Cancer Center Hospital in Nagoya, Japan, in an email to Reuters Health.

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