title: Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion.
abstract: OBJECTIVE
  The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients.
  
  
  METHODS
  The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients.
  
  
  RESULTS
  Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapse-free survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities.
  
  
  CONCLUSIONS
  Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ≥submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan.
authors.forename: Atsuki
authors.initials: A
authors.lastname: Ikeda
authors.forename: Namiko
authors.initials: N
authors.lastname: Hoshi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yoshizaki
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Fujishima
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ishida
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ejima
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakechi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokosaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004210:Dissection; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome