Treatment Options for Esophageal Submucosal Cancer from the Perspective of Endoscopic Treatment, Based on The Data of JCOG0508 Keiko Minashi 1,2 , Manabu Muto 3 1Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan 2Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan 3Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan Keyword: 食道表在癌 , 内視鏡的粘膜切除術 , EMR , 化学放射線療法 , CRT , 個別化治療 pp.1257-1264
Published Date 2020/9/25
DOI https://doi.org/10.11477/mf.1403202137
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 Esophageal submucosal cancer has a rate of lymph node metastasis percentage of 20%-40% ; therefore, surgical resection and chemoradiotherapy are recommended. However, it is difficult to clinically diagnose the depth of invasion, especially when the tumor is relatively shallow, and to accurately detect the presence or absence of lymphovascular invasion. Clinical submucosal cancer has sometimes been diagnosed as pathological mucosal cancer, and in such cases, a more aggressive approach, such as surgery or CRT(chemoradiotherapy), is undertaken. We considered a strategy in which endoscopic treatment is preceded by an evaluation of the tumor depth and lymphovascular invasion, where additional treatment is only administered to subjects with a high risk of lymph node metastasis. JCOG0508 showed the efficacy of diagnostic endoscopic resection followed by preventive CRT. In the future, a risk assessment of recurrence in such cases should be performed before using additional CRT, and the idea of deciding on the treatment strategy based on the improvement in the accuracy of preoperative diagnosis using image-enhanced endoscopy should be promoted.

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