Ali Al-Kaabi1, Erik J Schoon2, Pierre H Deprez3, Stefan Seewald4, Stefan Groth4, Marc Giovannini5, Barbara Braden6, Frieder Berr7, Arnaud Lemmers8, Jonathan Hoare9, Pradeep Bhandari10, Rachel S van der Post11, Rob H A Verhoeven12, Peter D Siersema1. 1. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. 2. Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands. 3. Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 4. Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland. 5. Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France. 6. Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 7. Department of Medicine I, Paracelsus Medical University, Salzburg, Austria. 8. Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 9. Department of Gastroenterology, Imperial College NHS Trust, London, UK. 10. Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK. 11. Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 12. Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
BACKGROUND AND AIMS: Definitive chemoradiotherapy (CRT) is increasingly used as a nonsurgical treatment for esophageal cancer. In Japanese studies, salvage endoscopic resection (ER) has emerged as a promising strategy for local failure after definitive CRT. We aimed to evaluate the safety and efficacy of salvage ER in a Western setting. METHODS: Gastroenterologists from Europe and the United States were invited to submit their experience with salvage endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) after definitive CRT. Participating gastroenterologists completed an anonymized database, including patient demographics, clinicopathologic variables, and follow-up on survival and recurrence. RESULTS: Gastroenterologists from 10 endoscopic units in 6 European countries submitted information on 25 patients. A total of 35 salvage ER procedures were performed, of which 69% were ESD and 31% EMR. Most patients had squamous cell carcinoma (64%) of the middle or lower esophagus (68%) staged as cT2-3 (68%) and cN+ (52%) before definitive CRT. The median time from end of definitive CRT to ER was 22 months (interquartile range, 6-47). The en-bloc resection rate was 92% for ESD and 46% for EMR. During a median of 24 months (interquartile range, 12-59) of follow-up after salvage ER, 52% developed a recurrence (11 locoregional, 2 distant). The 5-year recurrence-free survival, overall survival, and disease-specific survival were 36%, 52%, and 79%, respectively. No major intra- or postprocedural adverse events, such as bleeding or perforation, were reported. CONCLUSIONS: In carefully selected esophageal cancer patients, salvage ER is technically feasible after definitive CRT. Further prospective research is recommended to validate the safety and effectivity of salvage ER for the management of local failure.
BACKGROUND AND AIMS: Definitive chemoradiotherapy (CRT) is increasingly used as a nonsurgical treatment for esophageal cancer. In Japanese studies, salvage endoscopic resection (ER) has emerged as a promising strategy for local failure after definitive CRT. We aimed to evaluate the safety and efficacy of salvage ER in a Western setting. METHODS: Gastroenterologists from Europe and the United States were invited to submit their experience with salvage endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) after definitive CRT. Participating gastroenterologists completed an anonymized database, including patient demographics, clinicopathologic variables, and follow-up on survival and recurrence. RESULTS: Gastroenterologists from 10 endoscopic units in 6 European countries submitted information on 25 patients. A total of 35 salvage ER procedures were performed, of which 69% were ESD and 31% EMR. Most patients had squamous cell carcinoma (64%) of the middle or lower esophagus (68%) staged as cT2-3 (68%) and cN+ (52%) before definitive CRT. The median time from end of definitive CRT to ER was 22 months (interquartile range, 6-47). The en-bloc resection rate was 92% for ESD and 46% for EMR. During a median of 24 months (interquartile range, 12-59) of follow-up after salvage ER, 52% developed a recurrence (11 locoregional, 2 distant). The 5-year recurrence-free survival, overall survival, and disease-specific survival were 36%, 52%, and 79%, respectively. No major intra- or postprocedural adverse events, such as bleeding or perforation, were reported. CONCLUSIONS: In carefully selected esophageal cancerpatients, salvage ER is technically feasible after definitive CRT. Further prospective research is recommended to validate the safety and effectivity of salvage ER for the management of local failure.