Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Regeneration and Medicine Medical Center for Translation and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Radiat Oncol. 2020 Jun 1;15(1):133. doi: 10.1186/s13014-020-01582-8.
Endoscopic resection is widely used as an effective treatment for superficial esophageal cancer. However, the risk of lymph node metastasis increases in cases of muscularis mucosae or deeper invasion, for which additional treatment such as radiotherapy or surgery is required. Accordingly, the current study investigated the efficacy and toxicity of salvage radiotherapy after non-curative endoscopic resection as an organ preservation strategy.
We retrospectively reviewed 37 esophageal cancer patients who received salvage radiotherapy after non-curative endoscopic resection. The pathological invasion depths were the muscularis mucosae, submucosal layer, and muscularis propria in 14, 22, and one patient, respectively. All patients received external beam radiotherapy. Among them, eight received intraluminal brachytherapy following external beam radiotherapy. Elective nodal irradiation was administered to all patients. Twenty-five patients received concurrent platinum and fluorouracil-based chemotherapy.
The median follow-up time was 74 months (range: 3-212). The 5-year progression-free survival and overall survival rates were 64 and 78%, respectively. No local or regional lymph node recurrence was observed. The causes of death included esophageal cancer in one patient, metachronous esophageal cancer in one patient, other malignancies in eight patients, and other causes in six patients. Late cardiac toxicities ≥ grade 3 were observed in six patients, one of whom died of arrhythmia.
Salvage radiotherapy after non-curative esophageal endoscopic resection is an 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 elective nodal irradiation contributes to reduced regional node metastases.
内镜切除术被广泛应用于治疗早期食管癌。然而，对于黏膜肌层或更深层侵犯的病例，存在淋巴结转移风险增加的情况，需要进行放疗或手术等额外治疗。因此，本研究探讨了非治愈性内镜切除术后进行挽救性放疗作为器官保留策略的疗效和毒性。
我们回顾性分析了 37 例接受非治愈性内镜切除术后挽救性放疗的食管癌患者。病理浸润深度为黏膜肌层、黏膜下层和肌层的患者分别为 14、22 和 1 例。所有患者均接受外照射放疗。其中 8 例患者在外照射放疗后行腔内近距离放疗。所有患者均行选择性淋巴结照射。25 例患者接受顺铂联合氟尿嘧啶为基础的化疗。
中位随访时间为 74 个月（范围：3-212）。5 年无进展生存率和总生存率分别为 64%和 78%。未观察到局部或区域淋巴结复发。死亡原因包括 1 例食管癌、1 例异时性食管癌、8 例其他恶性肿瘤和 6 例其他原因。6 例患者出现≥3 级迟发性心脏毒性，其中 1 例死于心律失常。
非治愈性食管内镜切除术后进行挽救性放疗作为器官保留策略是有效的。尽管黏膜肌层和黏膜下层癌症存在淋巴结转移的高风险，但我们的结果表明选择性淋巴结照射有助于减少区域淋巴结转移。
