Reply to Yoshida et al.

 

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We thank Dr. Yoshida and colleagues for their remarks concerning our paper describing salvage endoscopic mucosal resection (EMR) in esophageal cancer patients with local failure after chemoradiotherapy [1]. In their letter, they reported a case of long-term survival after salvage EMR treatment for residual hypopharyngeal carcinoma after chemoradiotherapy. We consider that salvage EMR for hypopharyngeal cancer is the great challenge in terms of patients’ quality of life and organ preservation. Salvage total laryngopharyngectomy is profoundly invasive with a risk of severe complication, as with salvage esophagectomy. Therefore, we should be attempting to develop effective but less invasive salvage treatment options for local failure after chemoradiotherapy, with both esophageal cancer and head and neck cancers.

We have also reported preliminary data for salvage photodynamic therapy (PDT) for local failure after chemoradiotherapy for esophageal cancer [2]. Out of 13 patients with local failure, eight (62 %) achieved complete response with salvage PDT. Our data showed that salvage PDT could be a promising curative-intent treatment option after chemoradiotherapy. Lou et al. reported salvage interstitial PDT after radiotherapy or surgery for head and neck cancer [3]. In their study, patients received intravenous mesotetrahydroxyphenyl chlorin sensitizer and diode laser light delivered from fibers inserted directly into the target tumor. A total of 45 patients were treated in this way, of whom 41 had undergone previous treatment with radiotherapy. Nine of the 45 patients (20 %) had a complete response; moreover five patients were still alive more than a year later, without any recurrence. They concluded that salvage interstitial PDT can be an effective minimally invasive salvage treatment for patients with head and neck cancer who do not have further treatment options.

In our paper, we emphasized that detection of local failure at an early stage is crucial, and careful follow-up with endoscopy is still important even after chemoradiotherapy. Recently, the usefulness of narrow-band imaging (NBI) endoscopy for the detection of superficial pharyngeal cancer has been described [4], as Dr. Yoshida and colleagues mentioned in their report. The potential usefulness of NBI endoscopy for early detection of local failure after chemoradiotherapy is very interesting; this should be clarified with further study.

Finally, we consider that salvage EMR is the initial challenge with regard to head and neck cancer patients with local failure after chemoradiotherapy. However a larger study population would be necessary to confirm that EMR could be a curative treatment option even after chemoradiotherapy.

Competing interests: None

References

• 1 Yano T, Muto M, Hattori S. et al . Long-term results of salvage endoscopic mucosal resection in patients with local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma.  Endoscopy. 2008;  40 717-721
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• 2 Yano T, Muto M, Minashi K. et al . Photodynamic therapy as salvage treatment for local failures after definitive chemoradiotherapy for esophageal cancer.  Gastrointest Endosc. 2005;  62 31-36
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• 3 Lou P J, Jager H R, Jones L. et al . Interstitial photodynamic therapy as salvage treatment for recurrent head and neck cancer.  Br J Cancer. 2004;  91 441-446
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• 4 Muto M, Nakane M, Katada C. et al . Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal sites.  Cancer. 2004;  101 1375-1381
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T. YanoMD 

National Cancer Center Hospital East
Division of Digestive Endoscopy and GI Oncology

6-5-1, Kashiwanoha
Kashiwa 277-0882
Japan

Fax: +81-4-71346916

Email: toyano@east.ncc.go.jp