Post written by Keiichiro Nakajo, MD, from the Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.

In this retrospective, single-center study, enrolling almost 600 consecutive patients treated with endoscopic submucosal resection (ESD) for superficial esophageal squamous cell carcinoma, the patient cohort was stratified into 3 groups as follows: group A, salvage ESD after chemoradiotherapy (CRT) or radiotherapy (RT); group B, ESD for second primary lesions after CRT or RT; group C, conventional ESD for RT-naïve lesions. We also evaluated the effectiveness and safety of salvage ESD and ESD for second primary lesions and compared to those of conventional ESD. We found that ESD is safe and technically feasible in patients with local failure after CRT or RT, especially as initial salvage treatment and for second primary lesions within the irradiation field. No serious complications such as bleeding or perforation were noted in such patients, but the rates of procedural success, en bloc resection, and complete resection were significantly lower for salvage ESD than for conventional ESD. It should be noted that 3 of 4 patients with unsuccessful salvage ESD had a history of PDT for local failure, suggesting that, compared to CRT alone, CRT followed by PDT might result in more severe fibrosis. The procedure may be technically difficult in those with severe, chemoradiotherapy-induced fibrosis in the submucosal layer, who may require additional salvage endoscopic treatment.

We believe that our study makes a significant contribution to the literature because our study provides evidence regarding the technical feasibility of ESD for local failure, especially as an initial salvage treatment and as treatment for second primary lesions within the irradiation field, with safety and effectiveness comparable to those of conventional ESD.

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