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Feasibility of salvage endoscopic resection for patients with locoregional failure after definitive radiotherapy for pharyngeal cancer.

Satake H, Yano T, Yoda Y, Fujii S, Zenda S, Tomioka T, Shinozaki T, Miyazaki M, Kaneko K, Hayashi R - Endosc Int Open (2015)

Bottom Line: The safety of endoscopic resection for lesions within the radiation therapy (RT) field has not been assessed.Major complications associated with salvage endoscopic resection included aspiration pneumonia in 1 patient and a requirement for temporary tracheostomy in 3 patients.The 3-year survival rate was 68.6 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan.

ABSTRACT

Background and study aims: Local failure after radiation therapy for pharyngeal squamous cell carcinoma (PSCC) is problematic. The safety of endoscopic resection for lesions within the radiation therapy (RT) field has not been assessed. We evaluated salvage endoscopic resection in patients with locoregional failure after definitive radiotherapy for PSCC.

Patients and methods: We retrospectively evaluated the clinical outcomes and long-term survival of 16 patients initially treated with more than 60 Gy of radiation for PSCC. These patients later presented with 19 superficial metachronous or recurrent PSCC lesions within the radiation field and were treated with salvage endoscopic resection.

Results: Local recurrence developed at the primary site in 3 patients after a complete response to RT. The other 13 had multiple metachronous squamous cell carcinomas within the original RT field. Major complications associated with salvage endoscopic resection included aspiration pneumonia in 1 patient and a requirement for temporary tracheostomy in 3 patients. During a median follow-up period of 37 months (range, 2 - 72 months), 13 patients had no recurrence, 2 patients developed local recurrence, and 1 patient developed lymph node metastases. At present, 5 of the 16 patients have died: 2 of PSCC progression, 1 of esophageal squamous cell carcinoma, and the remaining 2 of unknown causes. The 3-year survival rate was 68.6 %.

Conclusions: Endoscopic resection is a potentially curative salvage treatment option for patients with superficial locoregional failure after definitive radiotherapy for PSCC.

No MeSH data available.


Related in: MedlinePlus

 Salvage endoscopic submucosal dissection with a DualKnife in a patient with locoregional failure after definitive radiotherapy for pharyngeal cancer. a Endoscopy with white light shows a reddish, flat lesion of the left aryepiglottic fold against the background of the white color of the edematous piriform sinus. b Endoscopy with narrow-band imaging shows a brownish neoplastic area. c Chromoendoscopy with 2.0 % iodine staining to demarcate the lesion. d Marking around the lesion with a DualKnife. e An adequate volume of 0.9 % saline solution mixed with a low volume of epinephrine (0.02 mg/mL) is injected into the subepithelial layer beneath the lesion. f Circumferential incision made with a DualKnife. g Induced ulcer after removal of the lesion.
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FI183-1:  Salvage endoscopic submucosal dissection with a DualKnife in a patient with locoregional failure after definitive radiotherapy for pharyngeal cancer. a Endoscopy with white light shows a reddish, flat lesion of the left aryepiglottic fold against the background of the white color of the edematous piriform sinus. b Endoscopy with narrow-band imaging shows a brownish neoplastic area. c Chromoendoscopy with 2.0 % iodine staining to demarcate the lesion. d Marking around the lesion with a DualKnife. e An adequate volume of 0.9 % saline solution mixed with a low volume of epinephrine (0.02 mg/mL) is injected into the subepithelial layer beneath the lesion. f Circumferential incision made with a DualKnife. g Induced ulcer after removal of the lesion.

Mentions: The details of the ESD method (with dissection from the subepithelial layer) with a knife (DualKnife, Olympus) are as follows (Fig. 1): Marking spots were made around the circumference of the lesion with the knife to determine the dissection range. Saline solution at a concentration of 0.9 % was injected into the subepithelial layer to create a subepithelial cushion. The initial incision was made just outside the marking spot, and a circumferential incision around the lesion was made with the knife. Subsequently, additional saline solution was injected into the subepithelial layer, allowing dissection of the subepithelial layer with the same device. After the lesion had been resected, vessels were coagulated to prevent delayed bleeding.


Feasibility of salvage endoscopic resection for patients with locoregional failure after definitive radiotherapy for pharyngeal cancer.

Satake H, Yano T, Yoda Y, Fujii S, Zenda S, Tomioka T, Shinozaki T, Miyazaki M, Kaneko K, Hayashi R - Endosc Int Open (2015)

 Salvage endoscopic submucosal dissection with a DualKnife in a patient with locoregional failure after definitive radiotherapy for pharyngeal cancer. a Endoscopy with white light shows a reddish, flat lesion of the left aryepiglottic fold against the background of the white color of the edematous piriform sinus. b Endoscopy with narrow-band imaging shows a brownish neoplastic area. c Chromoendoscopy with 2.0 % iodine staining to demarcate the lesion. d Marking around the lesion with a DualKnife. e An adequate volume of 0.9 % saline solution mixed with a low volume of epinephrine (0.02 mg/mL) is injected into the subepithelial layer beneath the lesion. f Circumferential incision made with a DualKnife. g Induced ulcer after removal of the lesion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554502&req=5

FI183-1:  Salvage endoscopic submucosal dissection with a DualKnife in a patient with locoregional failure after definitive radiotherapy for pharyngeal cancer. a Endoscopy with white light shows a reddish, flat lesion of the left aryepiglottic fold against the background of the white color of the edematous piriform sinus. b Endoscopy with narrow-band imaging shows a brownish neoplastic area. c Chromoendoscopy with 2.0 % iodine staining to demarcate the lesion. d Marking around the lesion with a DualKnife. e An adequate volume of 0.9 % saline solution mixed with a low volume of epinephrine (0.02 mg/mL) is injected into the subepithelial layer beneath the lesion. f Circumferential incision made with a DualKnife. g Induced ulcer after removal of the lesion.
Mentions: The details of the ESD method (with dissection from the subepithelial layer) with a knife (DualKnife, Olympus) are as follows (Fig. 1): Marking spots were made around the circumference of the lesion with the knife to determine the dissection range. Saline solution at a concentration of 0.9 % was injected into the subepithelial layer to create a subepithelial cushion. The initial incision was made just outside the marking spot, and a circumferential incision around the lesion was made with the knife. Subsequently, additional saline solution was injected into the subepithelial layer, allowing dissection of the subepithelial layer with the same device. After the lesion had been resected, vessels were coagulated to prevent delayed bleeding.

Bottom Line: The safety of endoscopic resection for lesions within the radiation therapy (RT) field has not been assessed.Major complications associated with salvage endoscopic resection included aspiration pneumonia in 1 patient and a requirement for temporary tracheostomy in 3 patients.The 3-year survival rate was 68.6 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan.

ABSTRACT

Background and study aims: Local failure after radiation therapy for pharyngeal squamous cell carcinoma (PSCC) is problematic. The safety of endoscopic resection for lesions within the radiation therapy (RT) field has not been assessed. We evaluated salvage endoscopic resection in patients with locoregional failure after definitive radiotherapy for PSCC.

Patients and methods: We retrospectively evaluated the clinical outcomes and long-term survival of 16 patients initially treated with more than 60 Gy of radiation for PSCC. These patients later presented with 19 superficial metachronous or recurrent PSCC lesions within the radiation field and were treated with salvage endoscopic resection.

Results: Local recurrence developed at the primary site in 3 patients after a complete response to RT. The other 13 had multiple metachronous squamous cell carcinomas within the original RT field. Major complications associated with salvage endoscopic resection included aspiration pneumonia in 1 patient and a requirement for temporary tracheostomy in 3 patients. During a median follow-up period of 37 months (range, 2 - 72 months), 13 patients had no recurrence, 2 patients developed local recurrence, and 1 patient developed lymph node metastases. At present, 5 of the 16 patients have died: 2 of PSCC progression, 1 of esophageal squamous cell carcinoma, and the remaining 2 of unknown causes. The 3-year survival rate was 68.6 %.

Conclusions: Endoscopic resection is a potentially curative salvage treatment option for patients with superficial locoregional failure after definitive radiotherapy for PSCC.

No MeSH data available.


Related in: MedlinePlus