Endoscopic Resection Plus Chemoradiotherapy Similar to Surgical Resection for 

High-risk Stage I Esophageal Cancer

Traditionally, surgical resection has been the standard for the treatment of patients with clinical stage I T1a-bN0M0 esophageal squamous cell cancer (ESSC). Given advances in therapeutic endoscopy, these patients could potentially be treated by endoscopic resection (ER). However, T1a patients with lymphovascular invasion (LVI) and those with T1b cancer have a high rate of lymph node metastasis. 

This multicenter study was conducted to evaluate the survival of patients with clinical stage I ESCC treated with ER and selective chemoradiotherapy (CRT) based on pathological tumor depth and LVI, compared with traditional surgical resection. Based on the histological evaluation of the initial ER specimen, additional treatment was selected: group A (n=74; pT1a cancer with negative resection margins and no LVI) had no additional treatment; group B (n=87; pT1b cancer with negative resection margins or pT1a cancer with LVI) underwent prophylactic CRT; and group C (n=15; with positive vertical resection margins or uncertain margins) received definitive CRT. The primary outcome was to evaluate whether the survival of group B and all enrolled patients was equivalent or superior to surgical resection at 5 years. The median follow-up for all patients was 81.5 months (range, 0.53-126.1).

The 5-year progression-free survival was 86.2% (95% confidence interval [CI], 77.0%-91.9%) for group B and 87.5% (95% CI, 81.6%-91.6%) for all enrolled patients. Similarly, the 5-year overall survival was 89.7% (95% CI, 81.1%-94.5%) for group B and 90.9% (95% CI, 85.6%-94.3%) for all enrolled patients.