Endoscopic Therapy Favored for Early Esophageal Cancer
Endoscopic therapy should be the standard treatment for early, low-risk esophageal malignancy, according to Christian Ell, MD, PhD, of the Dr. Horst Schmidt Klinik in Wiesbaden, Germany, who lectured at the 2011 American Society of Clinical Oncology Gastrointestinal Cancers Symposium.
“Surgery, in my eyes, is over-treatment and a method that should be reserved,” Dr. Ell told attendees at a session devoted to the diagnosis and management of esophageal cancer.
“Endoscopic treatment is associated with low morbidity rate and zero mortality, excellent long-term survival and preservation of quality of life,” he added.
In a recent case–control study from Dr. Ell’s group which compared endoscopic with surgical resection; disease-free survival and overall survival were similar for the two approaches. However, endoscopic resection was not associated with major complications, whereas 33% of surgical patients did suffer from some form of complication.
“This has held true for over 1,000 patients treated in Wiesbaden,” Dr. Ell noted.
In the study, five-year disease-free survival was 100% in the surgical group compared with 94% in the endoscopic treatment group (P=0.19), and five-year overall survival was 93% and 89% in the surgical and endoscopic groups, respectively (P=0.91).
Endoscopic therapy also maintains efficacy, Dr. Ell said, citing a published study of 349 patients who received endoscopic therapy for high-grade intraepithelial neoplasia or mucosal adenocarcinoma: 96.6% of subjects achieved a complete response, while survival at almost five years was approximately 80%. This is equivalent to survival within the normal German population, he noted.
Dr. Ell stressed that endoscopic treatment is appropriate only for early, low-risk cancers—those with a 0% risk for lymph node metastasis. Future goals of endoscopic therapy include safe and successful treatment of patients who are at low risk but have more than 2-cm or multifocal lesions, grade 3 histology and submucosal-1 infiltration, he said.
Dr. Ell acknowledged the drawbacks of the endoscopic approach. For example, there are no randomized studies to support the use of endoscopic therapy over surgery. “Outside of Wiesbaden, there have been only small series with short follow-up,” he said.
Prateek Sharma, MD, professor of medicine and director of fellowship training at the University of Kansas School of Medicine, in Kansas City, who was not involved in the study, said, “Dr. Ell, Dr. Pech and their group are to be congratulated for their excellent work in this field.