Follow Up and Surveillance of Esophageal Cancer Treated With Curative Intent

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Follow Up and Surveillance of Esophageal Cancer Treated With Curative Intent

  • Authors: Anne-Sophie Laliberté, MD. FRCSC
  • Reviewers : Brian Johnston and Andrew Seely

Society recommendations

Based on society recommendations and expert consensus, there is no high level of evidence to guide in the development of algorithms.

The majority of recurrences (44%)1 occur in the first two years following cancer treatment, but some have been described up to more than 5 years after. (NCCN)

In case of squamous cell carcinoma, we need to consider the possibility of metachronous cancer.

Incidence of esophageal cancer in Canada:

In 2019, Canadian Cancer Society estimate:

  • 2,300 Canadians will receive a diagnosis of esophageal cancer
  • 2,200 Canadians will die of esophageal cancer

Society recommendations reviewed:

Canadian, American, and French guidelines and recommendations were reviewed.

  • National Comprehensive Cancer Network (2019)
  • Canadian Cancer Society (2019)
  • NICE guidelines (2018)
  • Cancer Care Ontario
  • Thesaurus recommendations (2016)
  • ESMO Clinical Practice Guidelines (2013)
  • French guidelines OncoLogik (2019)

Follow up and surveillance of surgical patient by stage and type of resection:

Clinical and Physical examination:

  • Clinical and physical examination is recommended for all stages, the frequency is variable between the different society recommendations.
  • Follow up at 3, 6, 12, 18, 24 months and then annually.
  • Smoking cessation is recommended
  • Unscheduled evaluation if patient become symptomatic

.

Early Stage – Stage I:

Abbreviations

  • EMR: Endoscopic mucosal resection
  • RFA: Radiofrequency ablation
  • ESD: Endoscopic submucosal resection

.

Advanced Stage – Stage II&III:

Recommendations:

Summary of recommendations for endoscopic and radiologic surveillance after esophageal cancer resection
Stage Endoscopic surveillance Radiologic surveillance
Stage I – Recommended for local resection only: every 3months for one year, then every 6 months for the second year and then annually

– Recommended if residual Barrett’s esophagus

– Treatment of persistent Barrett’s esophagus is recommended

 – Radiologic surveillance isn’t recommended for Tis and T1a

– Annual CT-scan for 3 years is recommended for pT1b
Stage II & III – No evidence to recommend Endoscopic – CT-scan every 6 months for 2 years then annually

 

Summary of recommendations for endoscopic and radiologic surveillance after definitive chemoradiation for esophageal cancer
Stage Endoscopic surveillance Radiologic surveillance
Stage I – Endoscopic surveillance every 3-6 months for 2 years then annually – CT-scan every 6-9months if patient candidate for salvage esophagectomy
Stage II & III – Endoscopic surveillance every 3-6 months for 2 years, then every 6 months for the third year then clinically/ annually. – CT-scan every 6 months for the first 2 years if patient candidate for salvage esophagectomy, then clinically/annually.

Lifelong follow up is recommended.

Bibliograpy

Society

  • National Comprehensive Cancer Network (2019)
  • Canadian Cancer Society (2019)
  • Cancer Care Ontario
  • Thesaurus recommendations – Thésaurus National de Cancérologie Digestive (publish 23/09/2016)
  • French guidelines OncoLogik ( Esophageal adenocarcinoma :publish 14/05/2019 and Squamous cell carcinoma: publish 28/06/2018)

Articles

  1. Du Rieu M.C., Filleron T., Beluchon B. et al.Recurrence risk after Ivor Lewis oesophagectomy for cancer. Journal of Cardiothoracic Surgery 2013,8:213
  2. Mariam Naveed and Nisa Kubilium. Endoscopic Treatment of Early-Stage Esophageal Cancer. Curr Oncol Rep (2018) 20:71.
  3. Sharma, D. Katzka, N. Gupta et al. Quality Indicators for the Management of Barrett’sEsophagus, Dysplasia, and Esophageal Adenocarcinoma: Internation Consensus Recommendations from the American Gastroenterological Association Symposium. Gastroenterology. 2015;149(6):1599-1606.
  4. Stahk, C. Mariette, K. Haustermans et al. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Ann Oncol 2016;27 (suppl.5):v50-57