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Effect of chemoradiation on the development of second primary cancers after endoscopic resection of T1 esophageal squamous cell carcinoma

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Abstract

Background

Patients with early esophageal squamous cell carcinoma (ESCC) may develop multiple second primary ESCC and cancers in other organs even after curative endoscopic resection (ER). We investigated whether administration of chemoradiotherapy (CRT) after ER decreases the incidence of second primary cancers.

Methods

We conducted a post hoc analysis of the prospective study. Among the registered 170 patients with clinical submucosal ESCC, 74 underwent ER alone, and 96 underwent ER followed by CRT (ER + CRT) because of pathological results of submucosal or lympho-vascular invasion. We compared the incidence of second primary cancers in esophagus and in other organs between two treatment groups. A univariate analysis was performed to investigate the related risk factors. All patients were followed up with esophagogastroduodenoscopy and CT every 4 months for the first 3 years and every 6 months thereafter.

Results

Sixty-one ESCC were detected in 32 patients, and the 3-year cumulative incidence of multiple ESCCs was not different between ER + CRT and ER alone (10.4% vs. 13.5%). Sixty-three second primary cancers in other organs were detected in 45 patients, and there was no difference in the cumulative incidence between two groups. The risk factors for multiple ESCCs were high alcohol consumption and grade C multiple Lugol-voiding lesions. Heavy drinker or patients with grade C multiple Lugol-voiding lesion rather than CRT were at risk for second primary ESCC.

Conclusion

CRT after ER did not decrease the cumulative incidence of second primary ESCC nor cancers in other organs comparing with ER alone.

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Acknowledgements

We express our sincere thanks to all participating patients and their families. We thank the members of the JCOG Data Center/Operations Office for their support.

Funding

This study was supported in part by the National Cancer Center Research and Development Funds (23-A-16, 23-A-19, 26-A-4, 29-A-3, 2020-J-3), the Health and Labour Sciences Research Grant for Clinical Cancer Research (H17-12, H20-015), the Grant-in-Aid for Scientific Research (17S-3, 17S-5, 20S-3, 20S-6) from the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Department of Gastroenterology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Toshiyuki Yoshio

  2. Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan

    Keiko Minashi

  3. Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan

    Junki Mizusawa & Haruhiko Fukuda

  4. Department of Gastroenterology, Kobe University School of Medicine, Hyogo, Japan

    Yoshinori Morita

  5. Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo, Japan

    Yoshinori Morita

  6. Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan

    Masahiro Tajika

  7. Department of Endoscopy, Komagome Hospital, Tokyo, Japan

    Junko Fujiwara

  8. Department of Gastroenterological Oncology, Hyogo Cancer Center, Hyogo, Japan

    Yoshinobu Yamamoto

  9. Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan

    Chikatoshi Katada

  10. Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan

    Shinichiro Hori

  11. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan

    Tomonori Yano

  12. Division of Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, Hokkaido, Japan

    Kohei Takizawa

  13. Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Manabu Muto

Authors
  1. Toshiyuki Yoshio
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  2. Keiko Minashi
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  3. Junki Mizusawa
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  4. Yoshinori Morita
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  5. Masahiro Tajika
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  6. Junko Fujiwara
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  7. Yoshinobu Yamamoto
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  8. Chikatoshi Katada
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  9. Shinichiro Hori
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  10. Tomonori Yano
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  11. Kohei Takizawa
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  12. Haruhiko Fukuda
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  13. Manabu Muto
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Contributions

TY, KM, TY, KT, GO, and MM designed the research; GO, JM analyzed the data; TY wrote the manuscript; KM, GO, JM, YM, MT, JF, YY, CK, SH, TY, KT, HK, HF, and MM reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Toshiyuki Yoshio.

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Ethical Statement

This post hoc analysis was used collected data of JCOG0508 that complied with the Declaration of Helsinki requirements, of which the study protocol was approved by the institutional review boards of all participating institutions. The informed consent about the secondary use of the data was obtained from the enrolled patients at the registration to JCOG0508.

Conflict of interest

All authors declare no conflict of interest related to this article.

Participating institutions

Participating institutions Japan Clinical Oncology Group (JCOG) Gastrointestinal Endoscopy Study Group. Ibaraki Prefectural Central Hospital, Tochigi Cancer Center, National Cancer Center Hospital East, National Cancer Center Hospital, Chiba Cancer Center, Cancer Institute Hospital, Tokyo Metropolitan Komagome Hospital, Showa University, Toranomon Hospital, Kanagawa Cancer Center, Kitasato University Hospital, Yokohama City University Medical Center, Ishikawa Prefectural Central Hospital, Saku Central Hospital Advanced Care Center, Shizuoka Cancer Center, Aichi Cancer Center Hospital, Kyoto University, Osaka International Cancer Institute, Osaka City General Hospital, Osaka Medical Collage, Kobe University, Hyogo Cancer Center, Shikoku Cancer Center.

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Yoshio, T., Minashi, K., Mizusawa, J. et al. Effect of chemoradiation on the development of second primary cancers after endoscopic resection of T1 esophageal squamous cell carcinoma. Esophagus 19, 469–476 (2022). https://doi.org/10.1007/s10388-022-00917-6

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  • DOI: https://doi.org/10.1007/s10388-022-00917-6

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