REVIEW article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1527634
Additional chemoradiotherapy following endoscopic submucosal dissection in patients with esophageal squamous cell carcinoma: a narrative review
Provisionally accepted
- 1Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Region, China
- 2Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Region, China
- 3Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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This review offers a critical synthesis of additional therapeutic strategies following endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma, providing evidence-based recommendations to optimize clinical decision-making. For pT1a-EP/LPM lesions, ESD alone demonstrates curative potential with lymph node metastasis rates ranging from 0.0% to 3.3%. In contrast, pT1b-MM tumors exhibiting lymphovascular invasion warrant adjuvant chemoradiation therapy, associated with 21.4% nodal metastasis rates. For pT1b-SM1 lesions, chemoradiation is indicated-particularly demonstrating 13.2% nodal involvement without lymphovascular invasion versus 60.0% metastasis risk in cases with vascular invasion during observation. Timing of additional chemoradiotherapy should be expedited, with immediate initiation (1-2 months post-ESD) showing superior outcomes. Radiation dosing optimization reveals equivalent efficacy between lower radiation doses (40-41.4 Gy) and higher doses (50-50.4 Gy), with reduced treatment-related toxicity. Target volume delineation should prioritize the ESD bed with appropriate margins over elective nodal coverage, maintaining therapeutic efficacy while minimizing radiation exposure. The role of concurrent chemotherapy remains controversial, with retrospective evidence suggesting definitive radiotherapy may provide comparable local control.
Keywords: esophageal cancer, Endoscopic Submucosal Dissection, ESD, Surgery, Radiotherapy, chemotherapy
Received: 25 Nov 2024; Accepted: 27 May 2025.
Copyright: © 2025 Lin, Wang, Liang, Liu, Huang and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xin-Bin Pan, Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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