Clinical availability of endoscopic submucosal dissection for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma

• Published in: Journal of clinical oncology Vol. 30; no. 4_suppl; p. 118
• Main Authors: Inadomi, Kyoko, Watanabe, Masayuki, Nagai, Yohei, Nonaka, Koichi, Sakurai, Koichi, Ida, Satoshi, Iwagami, Shiro, Iwatsuki, Masaaki, Baba, Yoshifumi, Miyamoto, Yuji, Baba, Hideo
• Format: Journal Article
• Language: English
• Published: 01.02.2012
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2012.30.4_suppl.118

Abstract only 118 Background: Local failure after chemoradiotherapy (CRT) remains a major problem for patients with esophageal squamous cell carcinoma (ESCC), and there are few curative treatment options available in such cases except salvage esophagectomy. The aim of this study is to demonstrate the clinical efficacy and safety of endoscopic submucosal dissection as a salvage therapy (salvage ESD) for local failure after CRT. Methods: Between 2007 and 2011, 66 patients underwent ESD for superficial ESCC in our hospital. Five of these patients underwent salvage ESD for local failure after CRT, and were reviewed retrospectively. They were treated with CRT, consisting of 60 Gy irradiation and concurrent chemotherapy. The indications for salvage ESD were as follows: 1) absence of lymph-node or distant metastasis after CRT; 2) superficial and endoscopically resectable lesion after CRT; 3) refusal by patient to undergo salvage esophagectomy; 4) written informed consent. Salvage ESD was performed using a flush knife or hook knife with a hyaluronic acid injection into the submucosal layer. Results: The baseline stage before CRT was as follows: T1b/T2/T3 in 3/1/1, N0/1 in 4/1, and M0/1 in 4/1 patients, respectively. These 5 patients had histologically proven local failure, and the stage after CRT was as follows: T1a/T1b in 1/4, N0/1 in 5/0, and M0/1 in 5/0 patients, respectively. Salvage ESD was performed in all patients who had en bloc resection with no complications and pathologically R0 resection. In 5 patients, 2 had a pT1a lesion, and 3 had a pT1b lesion. 1 lesion recurred in other site 3 months after salvage ESD, which was resected successfully by a second ESD procedure. Conclusions: Salvage ESD is an available option for patients with local failure after CRT for ESCC.