SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2018/10  
 
  2018 Oct;88(4):637-646.  
  doi: 10.1016/j.gie.2018.06.033.  
 
  Technical feasibility of endoscopic submucosal dissection for local failure after chemoradiotherapy or radiotherapy for esophageal squamous cell carcinoma.  
 
  Nakajo K, Yoda Y, Hori K, Takashima K, Sinmura K, Oono Y, Ikematsu H, Yano T  
  https://www.ncbi.nlm.nih.gov/pubmed/30220299  
 
 

Abstract

BACKGROUND AND AIMS:

Salvage endoscopic submucosal dissection (ESD) after chemoradiotherapy can be technically difficult as a result of radiation-induced fibrosis. We aimed to evaluate the technical feasibility of ESD for local failure after chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) and for other primary lesions within the irradiation field.

METHODS:

Consecutive patients treated with ESD for superficial ESCC between December 2009 and May 2017 were investigated retrospectively and stratified into group A (33 patients, 35 lesions; local failure at the primary site after chemoradiotherapy), group B (25 patients, 34 lesions; second primary lesions within the irradiation field), and group C (550 patients, 596 lesions; radiotherapy-naïve superficial ESCC). We evaluated procedural success rate, en bloc resection rate, 1-year local relapse-free survival (LRFS) rate, procedure time, and incidence of major adverse events.

RESULTS:

The rates of procedural success and en bloc resection, respectively, were significantly lower in group A (89%, 86%) than in groups B (100%, 100%) and C (100%, 98%). The 1-year LRFS rates were 86%, 100%, and 99% in groups A, B, and C, respectively, and significantly lower in group A than in group C. Serious adverse events including perforation were not observed in groups A and B; perforation occurred only in group C (2.8%).

CONCLUSIONS:

ESD is technically feasible in patients with local failure, especially as initial salvage treatment and as treatment for second primary lesions within the irradiation field.

 

 
Question posée
 
Est-il possible (et raisonnable) de faire de la dissection sous-muqueuse oesophagienne après radiothérapie ?
 
Question posée
 
Le taux de résection complète monobloc varie de 86% à 100% selon la situation, avec aucune perforation notée dans les groupes des patients traités par radiothérapie.
 
Commentaires

Bien que monocentrique et rétrospectif, ce travail confirme qu’un antécédent de radiothérapie ne contre-indique pas la dissection sous-muqueuse, qui est le 1er traitement à envisager en cas de cancer épidermoïde superficiel de l’œsophage.

 
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