Radiotherapy after ESD improves survival of patients with LVI in pT1b ESCC

Adjuvant radiotherapy following endoscopic submucosal dissection (ESD) results in better survival in patients with lymphovascular invasion (LVI) in T1bN0M0 esophageal squamous cell cancer (ESCC), a study has shown.

This multicentre, cross-sectional study was conducted in 11 hospitals across China and included patients with T1bN0M0 ESCC treated with or without adjuvant radiotherapy after ESD between January 2010 and December 2019. The researchers then compared survival between the two groups.

A total of 774 patients underwent screening, of whom 161 were included. Forty-seven patients (29.2 percent) were treated with adjuvant radiotherapy following ESD (RT group) and 114 (70.8 percent) were not (non-RT group).

No significant differences in overall survival (OS) and disease-free survival (DFS) were observed between the RT and non-RT groups. The only prognostic factor noted was LVI.

Notably, adjuvant radiotherapy significantly improved survival (5-year OS: 91.7 percent vs 59.5 percent; p=0.050; 5-year DFS: 92.9 percent vs 42.6 percent; p=0.010) in the LVI+ group, but not in the LVI- group (5-year OS: 83.5 percent vs 93.9 percent; p=0.148; 5-year DFS: 84.2 percent vs 84.7 percent; p=0.907).

The standardized mortality ratio was 1.52 (95 percent confidence interval [CI], 0.04‒8.45) in the LVI+ group with radiotherapy and 0.55 (95 percent CI, 0.15‒1.42) in the LVI- group without radiotherapy.

“Selective adjuvant radiotherapy based on LVI status achieved survival rates similar to those of the general population,” the researchers said.