Chemoradiotherapy Safe, Effective for High-Risk Esophageal SCC

M. Alexander Otto, PA, MMS

August 12, 2022

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key takeaway

  • When initial endoscopic submucosal dissection (ESD) is not curative, chemoradiotherapy is a safe and effective alternative to esophagectomy for patients with superficial esophageal squamous cell carcinoma.

Why this matters

  • ESD is a standard treatment for superficial esophageal squamous cell carcinoma.

  • However, when there are positive resection margins, muscularis mucosae invasion, or submucosal invasion, patients need additional treatment.

  • Esophagectomy is the common approach, but it carries a high risk of serious complications, including perioperative death, lengthy recovery, and long-term dysphagia.

  • This study shows that chemoradiotherapy (CRT) is an appropriate alternative.

Study design

  • The study compared outcomes for 34 patients who underwent adjuvant CRT after noncurative ESD with outcomes for 26 patients who underwent esophagectomy.

  • A smaller irradiation field was used in the CRT group than in previous studies to reduce adverse events. In addition, the chemotherapeutic regimen (FP1000/75) was more potent.

  • The CRT group was older (median age, 69 vs 65 years).

  • The median follow-up was 4.9 years.

Key results

  • The 4-year overall survival rate was 84% in the CRT group, vs 92% with esophagectomy (P = .87).

  • The 4-year disease-free survival rate was 65% with CRT and 73% with esophagectomy (P = .41)

  • The incidence of grade 3 adverse events was 31% with CRT; there were no grade 4 events.

  • Serious adverse events in the esophagectomy group included three cases of recurrent nerve palsies, three anastomotic leaks, two respiratory complications, and one gastrointestinal complication

Limitations

  • It was a small, retrospective, single-institution investigation.

Disclosures

  • No funding was reported, and the investigators have disclosed no relevant financial relationships.

This is a summary of a preprint research study, "Chemoradiation Versus Surgery for Superficial Esophageal Squamous Cell Carcinoma After Noncurative Endoscopic Submucosal Dissection: Comparison of Long-Term Oncologic Outcomes," led by Gen Suzuki of the Kyoto Prefectural University of Medicine, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com. Email: aotto@mdedge.com.

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