PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): Endoscopic resection (ER) is widely used as an effective treatment for superficial esophageal cancer. However, the risk of lymph node metastasis increases in case of muscularis mucosae or deeper invasion, and additional treatment such as radiotherapy (RT) or surgery is required in those cases. The aim of this study is to investigate the efficacy and toxicity of salvage RT after incomplete ER as an organ preservation strategy.
Materials/Methods: We retrospectively reviewed 37 esophageal cancer patients received salvage RT after incomplete ER at one institution between 2000 and 2014. There were 34 males and 3 females, and the median age was 67 (range: 53-85). All patients had squamous cell carcinoma. Pathological invasion depth was muscularis mucosae/submucosal layer/muscularis propria in 14/22/1 patients, respectively. The circumference of tumor was less than three quarters in 25 patients, more than three quarters in 4 patients, entire in 4 patients and unknown in 4 patients. All patients received external beam radiotherapy (EBRT). Among them, 8 patients received intraluminal brachytherapy (IBT) following EBRT. Elective nodal irradiation (ENI) was administered in all patients. Median EBRT dose was 60 Gy/30 fractions (range: 50.4-66Gy). IBT was administered to a total dose of 10 Gy/4 fractions. Twenty-five patients received concurrent platinum and 5FU-based chemotherapy. The Kaplan–Meier method was used to generate actual survival curves. Fisher’s exact test was used for statistical comparisons.
Results: Median follow-up time was 56 months (range: 3-212) for all patients. The 5-year progression free survival and overall survival rates were 61% and 75%, respectively. Local recurrence and regional lymph node recurrence was not observed. Distant metastasis was observed in 2 patients (5%). Metachronous esophageal cancer was observed in 6 patients (16%) and 4 patients were salvaged by ER. The 5-years incidence rates of metachronaous tumor was 15%. Double cancer after RT was observed in 15 patients (41%). The causes of death were attributed to esophageal cancer in 1 patient, metachronous esophageal cancer in 1 patient, other malignancies in 8 patients and other causes in 6 patients. Although grade 2 esophageal stenosis was observed in 7 patients (19%), and significantly high in patients with tumor circumference more than 3/4 (p<0.001). Grade 3 or worth stenosis was not observed. Late cardiac toxicities ≥ grade 3 was observed in 6 patients (pericardial effusion in 2, ischemic heart disease in 1 and arrhythmia in 3 patients) and one patients died of arrhythmia.
Conclusion: Salvage radiotherapy after incomplete esophageal ER is effective treatment as an organ preservation strategy. Although muscularis mucosae and submucosal cancer have a high risk of lymph node metastasis, our results suggest that ENI contribute to reduce regional node metastases. Early detection of metachronous esophageal cancer and other malignancies is important for survivors.
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