Review of early endoscopic findings in patients with local recurrence after definitive chemoradiotherapy for esophageal
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ORIGINAL ARTICLE
Review of early endoscopic findings in patients with local recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma Yoichi Yamamoto1,2 · Tomohiro Kadota1 · Yusuke Yoda1 · Keisuke Hori1 · Ken Hatogai3 · Takashi Kojima3 · Satoshi Fujii4 · Tetsuo Akimoto2,5 · Tomonori Yano1 Received: 11 January 2020 / Accepted: 21 March 2020 © The Japan Esophageal Society 2020
Abstract Backgrounds Local recurrence after definitive chemoradiotherapy, if diagnosed early, can be cured by salvage endoscopic therapy, which allows organ preservation and contributes to maintaining patient quality of life. This study aimed to investigate early endoscopic findings of local recurrence in post-definitive chemoradiotherapy patients. Methods Between January 2008 and June 2012, 17 esophageal squamous cell carcinoma patients with no metastasis but local recurrence after definitive chemoradiotherapy were enrolled. We attempted to find endoscopic hallmarks suggestive of local recurrence by comparing pre- and post-local recurrence diagnostic images. The influence of follow-up schedule on chosen salvage therapy type was also investigated. Results Endoscopic local recurrence findings included eight submucosal tumors, five ulcers, and four erosions. Upon review of prior images, findings suggestive of local recurrence were detected in seven patients, including six submucosal tumors and one erosion, all of which were smaller than 10 mm. These lesions had changed morphologically at local recurrence diagnosis: three submucosal tumors had become larger and three submucosal tumors and one erosion had changed to ulcers. Of 12 patients with cT1 at local recurrence, four (33%) underwent follow-up endoscopy within 1 month of local recurrence findings and 11 patients (92%) were treated with salvage endoscopic therapy. Conclusions Endoscopists should be aware that SMTs or erosions, even those smaller than 10 mm, can indicate local recurrence after complete response to definitive chemoradiotherapy. Follow-up endoscopy should be performed within 1–2 months if findings suggestive of local recurrence are observed on prior endoscopy, even when biopsy results are negative. Keywords Chemoradiotherapy · Esophageal squamous cell carcinoma (ESCC) · Endoscopic therapy
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00734-9) contains supplementary material, which is available to authorized users. * Tomohiro Kadota [email protected] 1
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6‑5‑1, Kashiwanoha, Kashiwa, Chiba 277‑8577, Japan
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
2
Definitive chemoradiotherapy (dCRT) is widely accepted as a standard treatment for unresectable esophageal squamous cell carcinoma (ESCC). Some of the advantages of dCRT are organ preservation (in the form of marginal efficacy) and high complete response (CR) rates (
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