Su1505 Salvage Endoscopic Resection for Local Failure After Radiotherapy for Esophageal Squamous Cancer

Su1505 Salvage Endoscopic Resection for Local Failure After Radiotherapy for Esophageal Squamous Cancer Hogara Nishisaki*, Yoshinobu Yamamoto, Ikuya Miki, Masahiro Tsuda, Hideto Inokuchi Hyogo Cancer Center, Akashi, Japan Background: Endoscopic resection(ER;endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) was widely performed for superficial esophageal carcinoma in Japan. However, efficacy and safety of salvage ER for remnant and recurrent lesion with fibrosis after radiotherapy(RT) was little evaluated. Aims: To clarify the efficacy and safety of salvage ER for local failure after RT for esophageal cancer. Methods; We performed a single-institute retrospective study. The patients with local failure after radiotherapy (RT) for esophageal squamous carcinoma (ESCC) were enrolled . We evaluated the rate of curative resection, adverse events and toxicity related to ER. Results: We enrolled 16 patients with 19 lesions. 15 patients were male and one was female, and their median age was 63 (range: 50-85).The tumor location was the upper esophagus in 7 lesions, middle esophagus in 6 lesions and lower esophagus in 6 lesions. The baseline clinical stages before RT or local resection were : stage I in 12, stage II in 2, stage III in one and, stage IV in one patients. The irradiation dose for patients 60Gy in 13 patients, 50.4Gy in 2 patients and 70Gy in one patient. The failure patterns were recurrence after achieving a CR with CRT in 11 patients, and residual tumor just after CRT in 5 patients. The median tumor length was 22mm (range 8-55mm), and the circumference of the lumen was 12 lesions in 1/4, and 5 lesions in 1/4-1/2, and 2lesions in 1/2 . The T stage of the recurrent lesion was T1 in all patients. 7 lesions were performed with EMR, 12 lesions were performed with ESD. None of them had clinical lymph node or distant metastasis on CT evaluation before ER. The rate of en block, curative resection were 79%(15/19) and 79%(15/9),respectively. Esophageal stricture was observed in % (3/16). Neither bleeding nor perforation was observed. At the median follow up period of 28 months (range 3-135), no local recurrence and no metastasis was detected in 12 patients, the local recurrence was detected in one, the lymph node metastasis was detected in two patients, and the liver metastasis was detected in one patients. Conclusion: Salvage ER is a curative treatment option for patients with local failure after RT for esophageal squamous cell carcinoma.