title: Local efficacy and survival outcome of salvage endoscopic therapy for local recurrent lesions after definitive chemoradiotherapy for esophageal cancer.
abstract: BACKGROUND
  Salvage endoscopic therapy (SET), such as endoscopic mucosal resection (EMR) and photodynamic therapy (PDT), is a less-invasive treatment for local failure at the primary site after chemoradiotherapy (CRT) for esophageal squamous cell carcinoma (ESCC). We conducted this retrospective study to clarify the risk factors for local recurrence along with the long term results after SET for recurrent lesions after definitive CRT for ESCC.
  
  
  METHODS
  We enrolled 77 consecutive patients who underwent EMR or PDT for local recurrence without any metastasis after definitive CRT at our institution. We evaluated the local efficacy, local recurrence-free survival (LRFS), and overall survival (OS), and investigated the risk factors associated with survival outcome using a multivariate analysis.
  
  
  RESULTS
  The complete resection rate of EMR was 84.6 % (33/39), and the complete response rate for PDT was 65.8 % (25/38). Twenty-two patients (28.6 %) exhibited local recurrence without metastasis. Thirty-four patients (44.2 %) were alive at 5 years after undergoing only initial SET or with repeated SET. The 5-year LRFS rate was 59.6 %, and the presence of lesions occupying an esophageal circumference of 1/4 or larger was the only significant risk factor (HR: 3.10, 95 % CI: 1.35-7.15, P = 0.008). The 5-year OS rate was 48.4 %, and an advanced T factor before CRT was marginally associated with a poor OS (HR: 1.96, 95 % CI: 0.98-3.92, P = 0.055).
  
  
  CONCLUSIONS
  SET enabled a preferable local control and survival outcome for patients with local recurrence after definitive CRT for ESCC. Careful endoscopic follow-up is needed for patients with a large lesion before SET and those with an advanced T factor before CRT.
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. kn_hatogai@hotmail.com.|Department of Gastroenterology, Gastrointestinal Oncology division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. kn_hatogai@hotmail.com.|Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan. kn_hatogai@hotmail.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Hatogai
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. toyano@east.ncc.go.jp.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.affiliation: Department of Gastroenterology, Gastrointestinal Oncology division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. takojima@east.ncc.go.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. maonozaw@east.ncc.go.jp.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Onozawa
authors.affiliation: Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan. sfujii@east.ncc.go.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. hdaikou@east.ncc.go.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daiko
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. yusuke-yoda@amed.go.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoda
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. thonbu@east.ncc.go.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hombu
authors.affiliation: Department of Gastroenterology, Gastrointestinal Oncology division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. tdoi@east.ncc.go.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. kkaneko@east.ncc.go.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Department of Gastroenterology, Gastrointestinal Oncology division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. aohtsu@east.ncc.go.jp.|Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan. aohtsu@east.ncc.go.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ohtsu
mesh_terms: D000368:Aged; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D010778:Photochemotherapy / Q000379:methods; D016016:Proportional Hazards Models; D000069475:Re-Irradiation / Q000379:methods; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome