Endoscopic Resection for Superficial Esophageal Cancers

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.