Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.
Esophageal cancer is one of the most common and life-threating malignancies, and its incidence is rapidly increasing [
We conducted a retrospective review of the database in the Digestive Disease Center of Bundang CHA Hospital (Seongnam, Korea) and identified 28 patients who were diagnosed with EEC and consequently underwent ESD between May 2006 and January 2014. The ESD was performed according to the standard procedure of the Hospital (
The characteristics and comorbidities of all six patients (5 males, 1 female) are presented in
The median follow-up period was 63 (range, 29–124) months. During that period, local recurrence was not reported in any of our patients; however, metachronous cancer was detected in two patients after 3 and 7 years, respectively. One patient underwent esophagectomy with gastric reconstruction; the other patient received ESD followed by photodynamic therapy to prevent recurrence as pathological findings of his ESD specimen indicated positive lateral margins. Unfortunately, during the follow-up period, two of our patients showed esophageal stricture as a complication arising after CCRT; we performed balloon dilation to treat this complication.
The outcomes of endoscopic resection of EEC are comparable to those of surgical treatment, with low complication rates and a good quality of life [
(A) A flat elevated mucosal lesion, 2.5–3.0 cm in size and located 20–23 cm from the upper incisor, was detected during an esophagogastroduodenoscopy; (B) Magnification endoscopy revealed dilatation and irregular caliber changes of the intrapapillary capillary loop (IPCL-V1); (C) ESD was performed based on the biopsy results that suggested the presence of squamous cell carcinoma; (D) The specimen was 22×13 mm in size.
Cancer-invaded submucosal layer of Patients 2 and 5 are shown in panels (A) and (B), respectively.
Six Cases of Concurrent Chemoradiotherapy after ESD for the Treatment of Superficial Esophageal Cancer
No. | Date of diagnosis | Age/Sex | Location of tumor (from U.I) | Pre-ESD diagnosis | ESD results |
Progress |
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Diagnosis | Size (mm) | Depth of invasion | Resection margin | Lymphatic invasion | Vascular invasion | Follow-up period (mo) | Recurrence | |||||
1 | 2006-09 | 58/M | 20 cm | SqCC, MD | SqCC, MD | 22×13 | M3 | Free | Positive | Negative | 124 | No |
2 | 2010-07 | 61/M | 25 cm | SqCC, WD | SqCC, WD | 27×23 | SM3;450 μm | Free | Negative | Negative | 66 | No |
3 | 2010-10 | 69/F | 32 cm | SqCC, WD | SqCC, WD | 25×18 | M2 | Free | Positive | Negative | 75 | No |
4 | 2012-01 | 55/M | 32 cm | SqCC, WD | SqCC, WD | 22×41 | M2 | Free | Positive | Negative | 60 | No |
5 | 2014-01 | 65/M | 28 cm | SqCC, MD | SqCC, MD | 42×22 | SM1;150 μm | Free | Positive | Negative | 30 | No |
6 | 2014-07 | 67/M | 32 cm | SqCC, MD | SqCC, MD | 25×13 | M3 | Free | Positive | Negative | 29 | No |
ESD, endoscopic submucosal dissection; M, mucosa; MD, moderately-differentiated; SM, submucosa; SqCC, squamous cell carcinoma; U.I, upper incisor; WD, well-differentiated.
Patient Comorbidities
Patient no. | Date of diagnosis | Age/Diagnosis | |
---|---|---|---|
1 | 2006-09 | 58/M | Duodenal ulcer |
2 | 2010-07 | 61/M | Hypertension, chronic kidney disease |
3 | 2010-10 | 69/F | Early gastric cancer, laryngeal cancer, hypertension, cerebral infarction |
4 | 2012-01 | 55/M | Diabetes |
5 | 2014-01 | 65/M | Hypertension, benign prostate hypertrophy |
6 | 2014-07 | 67/M | None |