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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic debulking resection with additive chemoradiotherapy: Optimal management of advanced inoperable esophageal squamous cell carcinoma
Li-Hua Ren, Ye Zhu, Rong Chen, Mulmi Shrestha Sachin, Qin Lu, Wei-Hua Xie, Tong Lu, Xiao-Ying Wei, Rui-Hua Shi
Li-Hua Ren, Ye Zhu, Qin Lu, Rui-Hua Shi, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Rong Chen, Department of Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Mulmi Shrestha Sachin, Department of Gastroenterology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
Wei-Hua Xie, Quality Management, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Tong Lu, Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
Xiao-Ying Wei, Department of Pathology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
Author contributions: Ren LH contributed to data collection, data analysis, and manuscript writing; Zhu Y contributed to data collection and statistical methods; Chen R contributed to chemoradiotherapy; Sachin MS contributed to language editing; Lu Q contributed to technical guidance and the endoscopic debulking resection (EdR) procedure; Xie WH contributed to the data analysis; Lu T contributed to imaging interpretation; Wei XY contributed to pathology interpretation; Shi RH contributed to the conception and design of the study and performed the EdR procedure; All authors contributed to the revision and gave their final approval of the manuscript.
Supported by Fundamental Research Funds for the Central Universities, Postgraduate Research and Practice Innovation Program of Jiangsu Province, No. KYCX19_0118; Jiangsu Science and Technology Project, Innovative Team Project of Esophagus, No. 2017ZXK7QW08; and National Natural Science Foundation of China, No. 81570503.
Institutional review board statement: This study was approved by the institutional review board of Zhongda Hospital (No. 2019ZDSYLL023-Y01) and was conducted in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rui-Hua Shi, MD, PhD, Additional Professor, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Nanjing 210009, Jiangsu Province, China.
ruihuashi@126.com
Received: February 18, 2022
Peer-review started: February 18, 2022
First decision: May 9, 2022
Revised: May 22, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: September 15, 2022
Processing time: 202 Days and 22.3 Hours
BACKGROUND
There is no remedial strategy other than definitive chemoradiotherapy for patients with advanced esophageal squamous cell carcinoma (ESCC) who are not eligible to undergo surgical treatment.
AIM
To introduce a novel therapy called endoscopic debulking resection (EdR) followed by additive chemoradiotherapy (CRT) and evaluate its efficacy and safety.
METHODS
Advanced, inoperable ESCC patients between 1 January 2015 and 30 December 2019 were investigated retrospectively. Patients who received EdR followed by CRT were deemed the EdR + CRT group and those without CRT were deemed the EdR group. Overall survival (OS), progression-free survival (PFS), and adverse events were evaluated.
RESULTS
A total of 41 patients were enrolled. At a median follow-up of 36 mo (range: 1-83), the estimated 1-, 2-, and 3-year cumulative OS rates of patients who underwent EdR plus additive CRT were 92.6%, 85.2%, and 79.5%, respectively, which were higher than those of patients who underwent EdR alone (1-year OS, 83.3%; 2-year OS, 58.3%; 3-year OS, 50%; P = 0.05). The estimated 2-year cumulative PFS rate after EdR + CRT was 85.7%, while it was 61.5% after EdR (P = 0.043). According to the univariate and multivariate Cox regression analyses, early clinical stage (stage ≤ IIB) and additive CRT were potential protective factors for cumulative OS. No severe adverse events were observed during the EdR procedure, and only mild to moderate myelosuppression and radiation pneumonia were observed in patients who underwent additive CRT after EdR.
CONCLUSION
EdR plus CRT is an alternative strategy for selective advanced inoperable ESCC patients.
Core Tip: Forty-one advanced esophageal squamous cell carcinoma (ESCC) patients were retrospectively enrolled, including 28 patients who underwent endoscopic debulking resection (EdR) plus chemoradiotherapy (CRT) and 13 who received EdR without CRT. Clinicopathological characteristics, perioperative outcomes, cumulative overall survival (OS), and progression-free survival (PFS) rates were analyzed. Our results confirm that EdR is safe and feasible for advanced ESCC patients and that EdR + CRT showed better OS and PFS than EdR alone.
