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Endoscopic Salvage Following Radiotherapy for Oesophageal Cancer: A Systematic Review
H L Keenan1, R A Brooks1, C M Jones2
1Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Aim:
Definitive chemoradiotherapy (dCRT) is a standard of care for locally advanced oesophageal squamous cell carcinoma (OSCC) and adenocarcinoma (OAC). Following dCRT, many patients develop local residual or recurrent disease that is resectable via an endoscopic route. This avoids the need for an oesophagectomy, for which many patients are unfit and which is morbid. However, the toxicity and efficacy of post-radiotherapy endoscopic salvage has not been systematically assessed.
Materials And Methods:
A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. PubMed, Medline, Cochrane Library, Scopus, Web of Science and EMBASE databases were searched for terms relating to the endoscopic management of residual or recurrent disease following dCRT in oesophageal cancer. Data relating to tolerability, toxicity and efficacy were extracted from studies published between January 1990 and December 2025.
Results:
After screening, 45 studies were included, describing endoscopic management of 1970 residual or recurrent lesions (n = 976 endoscopic resections, n = 548 photodynamic therapy). Most (n = 43/45) focused on OSCCs. Reported overall survival at 3- and 5- years post-salvage ranged from 35-81% and 36-75%, respectively. The most frequently reported adverse events following endoscopic resection was stricture, in 0-21% of cases. There were no deaths in this group but five reported following photodynamic therapy, for which the most frequent adverse event was chest pain, in 25-54.9% of the population. No studies reported health-related quality of life measures.
Conclusion:
Endoscopic salvage following dCRT is feasible and there is evidence, albeit of low quality, for the safety and efficacy of this approach in OSCC. Few studies have reported on endoscopic salvage for OAC. Prospective data are required to evaluate survival outcomes, adverse events and health related quality of life associated with salvage endoscopic procedures in OAC and OSCC, and to confirm the optimal endoscopic treatment approach for both subtypes.