Additional radiotherapy following endoscopic submucosal dissection for T1a-MM/T1b-SM esophageal squamous cell carcinoma improves locoregional control.
Additional radiotherapy following endoscopic submucosal dissection for T1a-MM/T1b-SM esophageal squamous cell carcinoma improves locoregional control.
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DOI：
10.1186/s13014-018-0960-y
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发表时间：
2018-01-29
期刊：
影响因子：
--
通讯作者：
Honda H
中科院分区：
文献类型：
--
作者：
Hisano O;Nonoshita T;Hirata H;Sasaki T;Watanabe H;Wakiyama H;Ono M;Ohga S;Honda H
内镜下黏膜下剥离术（ESD）可作为累及黏膜肌层（T1a - MM）或黏膜下层上1/3（T1b - SM1）的表浅食管癌的一种微创治疗选择。ESD术后需要额外的治疗以预防淋巴结转移。然而，ESD术后放疗的疗效尚未得到充分评估。此外，ESD术后接受放疗的食管黏膜大面积缺损患者的临床结局尚未见报道。本研究旨在阐明ESD术后追加放疗对累及T1a - MM或T1b - SM1的食管鳞状细胞癌的疗效。
我们分析了27例经病理证实为T1a - MM或T1b - SM1食管鳞状细胞癌且接受ESD治疗的患者。13例患者接受了额外的放疗（放疗组），其余患者未接受（非放疗组）。对局部区域控制（LRC）、总生存期、病因特异性生存期以及包括治疗相关食管狭窄在内的不良事件进行了评估。
放疗组的3年LRC显著优于非放疗组（分别为100%对57.8%；p = 0.022）。ESD术后化疗并未改善LRC。多因素分析显示，放疗是改善LRC的独立预后因素（p = 0.0022）。与LRC的结果相反，放疗组和非放疗组的总生存期和病因特异性生存期无显著差异。对ESD术后食管周径黏膜缺损≥3/4的患者进行亚组分析显示，放疗组的LRC优于非放疗组（p = 0.049）。ESD术后黏膜大面积缺损的放疗组6例患者中有2例出现治疗相关食管狭窄。ESD术后食管周径黏膜缺损＜3/4的患者未出现治疗相关狭窄。
ESD术后放疗有助于改善累及pT1a - MM和pT1b - SM1的食管鳞状细胞癌的LRC。ESD术后黏膜大面积缺损的部分患者出现食管狭窄。尽管ESD术后放疗可改善LRC，但对于ESD术后黏膜大面积缺损的患者，应谨慎考虑后再进行放疗。
Endoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for superficial esophageal cancer involving the muscularis mucosae (T1a-MM) or upper third of the submucosa (T1b-SM1). Additional treatment after ESD is needed to prevent lymph node metastasis. However, the efficacy of radiotherapy following ESD has not been well evaluated. Moreover, the clinical outcomes of patients with large mucosal defects of the esophagus who received radiotherapy after ESD have not been reported. This study aimed to clarify the efficacy of additional radiotherapy following ESD for esophageal squamous cell cancer involving T1a-MM or T1b-SM1. We analyzed twenty-seven patients with pathologically confirmed T1a-MM or T1b-SM1 esophageal squamous cell cancer treated by ESD. Thirteen patients received additional radiotherapy (RT group), and the remaining patients did not (non-RT group). Locoregional control (LRC), overall survival, cause-specific survival, and adverse events including treatment-related esophageal strictures were evaluated. The three-year LRC was significantly better for the RT than the non-RT group (100% vs. 57.8%, respectively; p = 0.022). Chemotherapy following ESD did not improve LRC. Multivariate analysis showed that radiotherapy was an independent prognostic factor for better LRC (p = 0.0022). Contrary to the results in LRC, overall and cause-specific survival were not significantly different between the RT and non-RT groups. A subgroup analysis of patients with mucosal defects involving ≥ 3/4 of the esophageal circumference after ESD showed that LRC of the RT group was better than that of the non-RT group (p = 0.049). Treatment-related esophageal strictures were observed in 2 of 6 patients in the RT group with large mucosal defects after ESD. No patients with mucosal defects involving less than 3/4 of the circumference after ESD developed treatment-related strictures. Radiotherapy after ESD contributed to better LRC in esophageal squamous cell cancer involving pT1a-MM and pT1b-SM1. Esophageal strictures were observed in some patients with large mucosal defects after ESD. Despite leading to better LRC, radiotherapy after ESD should be undertaken after careful consideration for patients with large mucosal defects after ESD.
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DOI：
10.1016/j.ijrobp.2011.01.047
发表时间：
2012-04-01
影响因子：
7
作者：
Atsumi, Kazushige;Shioyama, Yoshiyuki;Honda, Hiroshi
通讯作者：
Honda, Hiroshi
DOI：
10.4291/wjgp.v3.i2.44
发表时间：
2012-04-15
期刊：
World journal of gastrointestinal pathophysiology
影响因子：
--
作者：
Honda, Kuniomi;Akiho, Hirotada
通讯作者：
Akiho, Hirotada
影响因子：
2.7
作者：
Mochizuki, Yosuke;Saito, Yasuharu;Andoh, Akira
通讯作者：
Andoh, Akira
影响因子：
2.4
作者：
Kurokawa Y;Muto M;Minashi K;Boku N;Fukuda H;Gastrointestinal Oncology Study Group of Japan Clinical Oncology Group (JCOG)
通讯作者：
Gastrointestinal Oncology Study Group of Japan Clinical Oncology Group (JCOG)
影响因子：
7.5
作者：
Eguchi, T;Nakanishi, Y;Umemura, S
通讯作者：
Umemura, S