Abstract
Esophageal cancer is a disease with a poor prognosis. As with superficial esophageal cancers, lymph node metastases are seen rarely if the tumors are limited to the epithelium or lamina propria, but when cancers invade the submucosa, there is a high incidence of lymph node involvement. Surgery with radical lymph node dissection is a standard treatment for treating submucosal esophageal cancers. However, it is usually associated with a reduced level of quality of life for the patients, who are often elderly and have various medical complications making them unfit for aggressive surgery. According to these background indications, various nonsurgical treatments have been developed to preserve the esophagus and to achieve a less invasive cure for such patients. Definitive radiotherapy could be a treatment option for patients with superficial carcinomas, particularly for those with mucosal cancers with an unresectable width by endoscopic mucosal resection (EMR). Although there have been some retrospective analyses with a small number of patients, they could not draw definitive conclusions. Definitive chemoradiotherapy has become one of the treatment options for patients who desire nonsurgical treatment. It has shown similar survival rates with those seen for radical surgery in two retrospective analyses and one multicenter prospective phase II study. The combination of primary EMR and prophylactic chemoradiotherapy has also shown promising results with less invasiveness than surgery. These nonsurgical approaches are now under evaluation in two multi-institutional studies run by the Japan Clinical Oncology Group (JCOG), which will clarify the optimal treatment for this disease.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
The Editorial Board of the Cancer Statistics in Japan. Cancer Statistics in Japan 2005. Tokyo: Foundation for Promotion of Cancer Research; 2005.
National Cancer Institute. Cancer topics. Esophageal cancer: Available from: http://www.nci.nih.gov/cancertopics/types/esophageal.
Kodama M, Kakegawa T. Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan. Surgery (St. Louis) 1998;123:432–439.
Igaki H, Kato H, Tachimori Y, Daiko H, Fukaya M, Yajima S, et al. Clinicopathologic characteristics and survival of patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothoracic Surg 2001;20:1089–1094.
Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 2000;232:225–232.
Gotohda N, Nishimura M, Yoshida J, Nagai K, Tanaka N. The pattern of lymphatic metastasis in superficial squamous cell carcinoma of the esophagus. Hepatogastroenterology 2005;52:105–107.
Okawa T, Tanaka M, Kita-Okawa M, Nishio M, Kikuchi Y, Shirato H, et al. Superficial esophageal cancer: multicenter analysis of results of definitive radiation therapy in Japan. Radiology 1995;196:271–274.
Ishikawa H, Sakurai H, Tamaki Y, Nonaka T, Yamakawa M, Saito Y, et al. Radiation therapy alone for stage I (UICC T1N0M0) squamous cell carcinoma of the esophagus: indications for surgery or combined chemoradiotherapy. J Gastroenterol Hepatol 2006;21:1290–1296.
Nishimura Y, Okuno Y, Ono K, Mitsumori M, Nagata Y, Hiraoka M. External beam radiation therapy with or without high-dose-rate intraluminal brachytherapy for patients with superficial esophageal carcinoma. Cancer (Phila) 1999;86:220–228.
al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol 1997;15:277–284.
Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA 1999;281:1623–1627.
Nemoto K, Yamada S, Nishio M, Aoki M, Nakamura R, Matsumoto Y, et al. Results of radiation therapy for superficial esophageal cancer using the standard radiotherapy method recommended by the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group. Anticancer Res 2006;26:1507–1512.
Ura T, Muro K, Shimada Y, Shirao K, Igaki H, Tachimori Y, et al. Definitive chemoradiotherapy may be standard treatment options in clinical stage I esophageal cancer. Proc Am Soc Clin Oncol 2004;22 (abstract 4017).
Minashi K, Doi T, Muto M, Mera K, Yano T, Ohtsu A. Chemoradiotherapy for superficial esophageal squamous cell carcinoma. Stomach Intest 2006;41:1467–1474.
Kato H, Fukuda H, Udagawa H, Togo A, Ando N, Tanaka O, et al. A phase II trial of chemo-radiotherapy in patients with stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group study (JCOG 9708). Proc Am Soc Clin Oncol 2003;22:286a (abstract 1147).
Swisher SG, Wynn P, Putnam JB, Mosheim MB, Correa AM, Komaki RR, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg 2002;123:175–183.
Hattori S, Muto M, Ohtsu A, Boku N, Manabe T, Doi T et al. EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc 2003;58:65–70.
Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Tsukagoshi H, Fujita M, et al. EMR combined with chemoradiotherapy: a novel treatment for superficial esophageal squamous-cell carcinoma. Gastrointest Endosc 2004;59:199–204.
Minashi K, Muto M, Yano T, Ohtsu A, Nihei K. Endoscopic mucosal resection (EMR) combined chemoradiotherapy (CRT) for esophageal submucosal cancer. Annu MeetJpn Soc Med Oncol 2006;4:218 (abstract).
Ishikura S, Nihei K, Ohtsu A, Boku N, Hironaka S, Mera K, et al. Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of thoracic esophagus. J Clin Oncol 2003;21:2697–2702.
Author information
Authors and Affiliations
Corresponding author
Additional information
Review articles on this topic also appeared in the previous issue (Volume 4 Number 3). An editorial related to this article is available at http://dx.doi.org/10.1007/s10388-007-0119-7.
Rights and permissions
About this article
Cite this article
Minashi, K., Muto, M. & Ohtsu, A. Nonsurgical treatments for submucosal esophageal squamous cell carcinomas. Esophagus 4, 159–164 (2007). https://doi.org/10.1007/s10388-007-0138-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-007-0138-4