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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic debulking resection with additive chemoradiotherapy: Optimal management of advanced inoperable esophageal squamous cell carcinoma
Li-Hua Ren, Ye Zhu, Rong Chen, Mulmi Shrestha Sachin, Qin Lu, Wei-Hua Xie, Tong Lu, Xiao-Ying Wei, Rui-Hua Shi
Li-Hua Ren, Ye Zhu, Qin Lu, Rui-Hua Shi, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Rong Chen, Department of Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Mulmi Shrestha Sachin, Department of Gastroenterology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
Wei-Hua Xie, Quality Management, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Tong Lu, Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
Xiao-Ying Wei, Department of Pathology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
Author contributions: Ren LH contributed to data collection, data analysis, and manuscript writing; Zhu Y contributed to data collection and statistical methods; Chen R contributed to chemoradiotherapy; Sachin MS contributed to language editing; Lu Q contributed to technical guidance and the endoscopic debulking resection (EdR) procedure; Xie WH contributed to the data analysis; Lu T contributed to imaging interpretation; Wei XY contributed to pathology interpretation; Shi RH contributed to the conception and design of the study and performed the EdR procedure; All authors contributed to the revision and gave their final approval of the manuscript.
Supported by Fundamental Research Funds for the Central Universities, Postgraduate Research and Practice Innovation Program of Jiangsu Province, No. KYCX19_0118; Jiangsu Science and Technology Project, Innovative Team Project of Esophagus, No. 2017ZXK7QW08; and National Natural Science Foundation of China, No. 81570503.
Institutional review board statement: This study was approved by the institutional review board of Zhongda Hospital (No. 2019ZDSYLL023-Y01) and was conducted in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rui-Hua Shi, MD, PhD, Additional Professor, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Nanjing 210009, Jiangsu Province, China. ruihuashi@126.com
Received: February 18, 2022
Peer-review started: February 18, 2022
First decision: May 9, 2022
Revised: May 22, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: September 15, 2022
ARTICLE HIGHLIGHTS
Research background
Advanced esophageal squamous cell carcinoma (ESCC) patients who decline surgery or have high surgical risks have no treatment option but definitive chemoradiotherapy (dCRT). However, the complications from high doses of radiation and local recurrence result in a poor prognosis.
Research motivation
To explore a new therapy to treat patients diagnosed with advanced ESCC who were unable to undergo surgery and to extend this therapy to patients with deeper than T1b (≥ SM3) invasion who were unwilling or unable to receive additional esophagectomy.
Research objectives
To evaluate efficacy and safety of the strategy of endoscopic debulking resection (EdR) with additive chemoradiotherapy (CRT) for selected advanced ESCC patients.
Research methods
Patients who received (EdR) followed by CRT were deemed the EdR + CRT group and those without CRT were deemed the EdR group. Outcomes of overall survival (OS), progression-free survival (PFS), and adverse events were evaluated.
Research results
This study showed promising short-term overall and cancer-specific survival after EdR plus additive CRT, with estimated 1-, 2-, and 3-year cumulative OS rates of 92.6%, 85.2%, and 79.5%, respectively, and a 2-year cumulative PFS rate of 85.7%. Early clinical stage (stage ≤ IIB) and additive CRT were potential protective factors for cumulative OS.
Research conclusions
EdR plus CRT is relatively safe and feasible for selected advanced inoperable ESCC patients.
Research perspectives
The authors will continue to follow up the enrolled patients and increase the sample size to validate the endoscopic advantages and disadvantages.
