title: The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer.
abstract: BACKGROUND
  To evaluate the risks and benefits of endoscopic submucosal dissection (ESD) in addition to chemoradiotherapy (CRT) for the treatment of superficial esophageal squamous cell carcinoma (SESCC).
  
  
  METHODS
  We retrospectively reviewed the treatment outcomes of 47 patients with SESCC treated between October 2000 and December 2011. Sixteen patients with invasion into the submucosal layer (T1b) or the muscularis mucosa (m3) with positive vascular invasion were treated with CRT after ESD (ESD-CRT group). The lymph node area was irradiated to a total dose of 40-44 Gy and a boost radiation was administered if PET-positive lymph nodes or positive margins were observed. The remaining 31 patients received definitive CRT only (dCRT group).
  
  
  RESULTS
  The radiation field was significantly larger in the ESD-CRT group; the "long T" was used in 11 patients (35.4%) in the dCRT group and 15 (93.7%) in the ESD-CRT group (p = 0.0001). The total radiation dose was smaller in the ESD-CRT group; 40 Gy was used in 10 patients (62.5%) in the ESD-CRT group and all but one patient in the dCRT group received ≥60 Gy (p = 0.00001). The 3-year overall survival rates in the dCRT and ESD-CRT groups were 63.2% and 90.0% respectively (p = 0.118). Recurrence developed in nine patients (29.0%) in the dCRT group and one (6.3%) in the ESD-CRT group. Local recurrence was observed in six patients (19%) in the dCRT group and none in the ESD-CRT-group (p = 0.029). Pericardial effusion (≥Grade 3) occurred in three patients (9.7%) in the dCRT group and none in the ESD-CRT group.
  
  
  CONCLUSIONS
  ESD followed by CRT is an effective and safe approach for SESCC at m3 or T1b. This combination of ESD and CRT improves the local control rate, and it could decrease the number of cardiac toxicities due to a radiation-dose reduction relative to CRT alone.
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. gen-kawa@umin.ac.jp.
authors: Gen
authors: G
authors: Kawaguchi
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. rsasa@clg.niigata-u.ac.jp.
authors: Ryuta
authors: R
authors: Sasamoto
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. eabe@med.niigata-u.ac.jp.
authors: Eisuke
authors: E
authors: Abe
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. ao4854@gmail.com.
authors: Atsushi
authors: A
authors: Ohta
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. spt34r29@space.ocn.ne.jp.
authors: Hiraku
authors: H
authors: Sato
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. ktanaka510218@gmail.com.
authors: Kensuke
authors: K
authors: Tanaka
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. kmaruyam@med.niigata-u.ac.jp.
authors: Katsuya
authors: K
authors: Maruyama
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. kaidu@med.niigata-u.ac.jp.
authors: Motoki
authors: M
authors: Kaizu
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. ayukawa@yahoo.co.jp.
authors: Fumio
authors: F
authors: Ayukawa
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. n-yamana0713@ma.tlp.ne.jp.
authors: Nobuko
authors: N
authors: Yamana
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. junyangl@163.com.
authors: Junyang
authors: J
authors: Liu
authors: Departments of Gastroenterology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. yasuzuka2000@yahoo.co.jp.
authors: Manabu
authors: M
authors: Takeuchi
authors: Departments of Gastroenterology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. masakoba@med.niigata-u.ac.jp.
authors: Masaaki
authors: M
authors: Kobayashi
authors: Departments of Radiation Oncology, Niigata University Medical and Dental Hospital, Asahimachi-dori, Chuo-ku, Niigata, Japan. h-aoyama@med.niigata-u.ac.jp.
authors: Hidefumi
authors: H
authors: Aoyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004210:Dissection; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D015996:Survival Rate
references: Esophagus. 2016;13:110-137
references: 27110229
references: Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):487-93
references: 23968770
references: Ann Surg. 2013 Jun;257(6):1032-8
references: 23108117
references: Histopathology. 2007 Dec;51(6):733-42
references: 17617215
references: Ann Surg Oncol. 2012 Jul;19(7):2135-41
references: 22302264
references: Am J Surg. 2005 Jan;189(1):98-109
references: 15701501
references: Jpn J Clin Oncol. 2009 Oct;39(10):686-9
references: 19703839
references: World J Gastrointest Pathophysiol. 2012 Apr 15;3(2):44-50
references: 22532931
references: Jpn J Clin Oncol. 2009 Oct;39(10):638-43
references: 19549720
references: Int J Radiat Oncol Biol Phys. 1998 Jan 1;40(1):155-61
references: 9422572
references: Am J Gastroenterol. 2011 Jun;106(6):1048-54
references: 21343920
references: Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):707-14
references: 18191334
references: Ann Surg Oncol. 2008 Nov;15(11):3278-88
references: 18726651
references: J Am Coll Surg. 2002 Mar;194(3):285-97
references: 11893132
references: Gastrointest Endosc. 2004 Feb;59(2):199-204
references: 14745392
references: Clin Gastroenterol Hepatol. 2005 Jul;3(7 Suppl 1):S67-70
references: 16013002