Digestive Diseases and Sciences

, Volume 58, Issue 6, pp 1477–1485

Endoscopic Management of Esophageal Cancer After Definitive Chemoradiotherapy

Review

DOI: 10.1007/s10620-012-2554-0

Cite this article as:
Khangura, S.K. & Greenwald, B.D. Dig Dis Sci (2013) 58: 1477. doi:10.1007/s10620-012-2554-0

Abstract

Background

Concurrent chemoradiotherapy (CRT) is a potentially curative non-surgical option for locally advanced esophageal cancer, with pathological complete response (CR) ranging from 13 to 49 %. The rate of persistent and recurrent disease within the esophagus remains high at 40–60 %, and treatment of these tumors may improve disease-free survival. The aim of this review is to assess the efficacy of salvage endoscopic therapies for recurrent esophageal cancer.

Methods

Medline and Embase were searched for relevant studies published in the English-language literature that reported use of endoscopic modalities, including photodynamic therapy (PDT), endoscopic mucosal resection (EMR), and spray cryotherapy, as salvage therapies for esophageal cancer.

Results

A total of 12 studies were identified. In small case series of PDT, CR varied from 20 to 100 %, with 1-, 3-, and 5-year overall survival rates of 65–80, 34–47, and 36 %, respectively. Data from three studies of EMR in squamous cell cancer show CR in 50 % of cases, with 3- and 5-year overall survival of 56–81 and 49 %, respectively. Endoscopic spray cryotherapy has recently been used in this setting with an observed CR of 37.5 %.

Conclusions

Endoscopic salvage therapies are options for those patients with disease limited to the superficial esophageal wall and those who are unfit to undergo salvage esophagectomy. Widespread application of endoscopic salvage therapies is limited by the lack of awareness and guidelines for endoscopic surveillance post-CRT and limited data on the effectiveness of endoscopic therapies.

Keywords

Esophageal cancerSalvage therapiesPhotodynamic therapyEndoscopic mucosal resectionCryotherapy

Abbreviations

CR

Complete response

CRT

Definitive concurrent chemoradiotherapy

CT

Computed tomography

EMR

Endoscopic mucosal resection

EUS

Endoscopic ultrasound

FDG

Fluoro-2-deoxy-D-glucose-positron emission tomography

FNA

Fine needle aspiration

PDT

Photodynamic therapy

PET

Positron emission tomography

RFA

Radiofrequency ablation

SUV

Standardized uptake value

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaUSA
  2. 2.Division of Gastroenterology and HepatologyUniversity of Maryland Medical CenterBaltimoreUSA
  3. 3.Division of Gastroenterology and Hepatology, Department of Medicine and Greenebaum Cancer CenterUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.JacksonUSA