Introduction: Surgical resection along with chemotherapy and radiation therapy has remained the mainstay of treatment for patients with Squamous Cell Carcinoma (SCC) of Esophagus (SCCoE), yet some patients are refractory to standard treatment options. We report the first case of cryoablation used to treat persistent high-grade dysplasia (HGD) in a localized SCCoE after a complete cycle of chemotherapy and radiation.
Case Description/Methods: An 82-year-old male with history of COPD, prostate and lung adenocarcinoma underwent routine surveillance PET scan with findings of abnormal uptake in the mid-esophagus with associated wall thickening, concerning for primary versus metastatic cancer. Patient denied any symptoms of dysphagia, heartburn, regurgitation, or family history of esophageal cancer (EC). Esophagogastroduodenoscopy (EGD) found a 20x14 mm mid-esophageal mass with biopsy and staging work-up with EUS identifying stage Ib/IIa SCC. Due to his age and comorbidities, the patient was deemed high risk for esophagectomy and underwent chemoradiation. Repeat surveillance EGD six months after chemoradiation showed resolved mass but biopsy showed HGD with background candida esophagitis treated with oral fluconazole and PPI therapy. Tumor board consensus was surveillance; repeat EGD performed 6 months later showed persistent moderate to severe HGD. Due to the persistent HGD, the patient was offered cryoablation therapy to reduce risk of recurrence of SCCoE. The patient underwent 1 round of 7 applications of cryoablation (C2TM) for 10 seconds each. Repeat EGD at 4 months post-cryoablation showed no residual HGD or cancer. Clinically, the patient continues to do well post-cryoablation in remission at 9 months since Cryoablation.
Discussion: Limited non-surgical options exist for SCCoE, especially in cases of persistent or refractory HGD after chemoradiation therapy. Cryoablation is a promising treatment option, but most studies are reported in a pre-chemoradiation state. A study performed by Greenwald, et al. identified endoscopic spray cryotherapy (truFreezeTM) as a safe and efficacious modality of treatment for EC, while a study by Canto et al. showed high efficacy in eradication of early dysplasia with cryoballoon. Our presented patient is the first reported case of successful eradication of persistent SCCoE despite chemoradiation. The plan for further EGD will establish remission of the disease, and likely open cryoablation as a non-surgical treatment for SCCoE.
Figure: Endoscopic Captures. Top row - EGD with Esophageal mass white light and narrow band imaging Middle row - EGD post chemo-radiation therapy with resolved but persistent HGD and Cryoballoon application Bottom row - Immediate post cryoablation on left and resolved HGD at 4 months follow-up post Cryoablation
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Viraj Modi indicated no relevant financial relationships.
Bhavtosh Dedania indicated no relevant financial relationships.
Viraj D. Modi, DO1, Bhavtosh Dedania, MD2. P3992 - Successful Cryoablation for Refractory High Grade Dysplasia in Squamous Cell Carcinoma of Esophagus, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
