Not All Patients Require Radiotherapy After ESD for T1b Esophageal Cancer

Endoscopic resection (ER) plays a critical role in both treating and diagnosing superficial esophageal cancer. However, the incidence of lymph node metastasis in patients with pT1b esophageal squamous cell cancer (ESCC; cancer invading into submucosa) is relatively high; therefore, it is advisable to pursue supplementary treatment following ER. The efficacy of adjuvant radiotherapy following endoscopic submucosal dissection (ESD) for pT1b ESCC remains uncertain. Thus, the purpose of this study was to assess whether additional radiotherapy can enhance patient survival.

This retrospective cross-sectional study involved 774 patients with T1bN0M0 ESCC treated with or without adjuvant radiotherapy following ESD across 11 hospitals in China. Of these patients, 161 were included in the study, with 29.2% receiving adjuvant radiotherapy (RT group) and 70.8% undergoing just ESD (non-RT group). No significant differences in overall survival (OS) and disease-free survival (DFS) were observed between the two groups. Lymphovascular invasion (LVI) was the only prognostic factor, with adjuvant radiotherapy significantly improving survival in the LVI-positive group but not in the LVI-negative group. The standardized mortality ratios were 1.52 in the group with LVI and radiotherapy and 0.55 in the group without LVI and radiotherapy.