RFA of Squamous Dysplasia
We had a question about squamous cell dysplasia, which is related to squamous cell cancer of the esophagus. Squamous dysplasia and squamous cell cancer of the esophagus have different causes than esophageal adenocarcinoma, which is the type of cancer related to Barrett’s esophagus. Diagnosis is often made with upper endoscopy (EGD) and Lugol’s iodine may be sprayed onto the lining of the esophagus to help locate areas of dysplasia. Treatment of squamous cell cancer of the esophagus can include surgery to remove the esophagus, radiation, and chemotherapy.
One reader asked about radiofrequency ablation (RFA) for squamous cell dysplasia. Most of the research using RFA has been performed in patients with Barrett’s esophagus. There are a few very small reports of RFA being used in squamous dysplasia.
One abstract at Digestive Disease Week (international GI meeting) this year looked at 7 patients with squamous dysplasia of the esophagus.
- - The patients in the study were not eligible for surgery, most likely due to other health problems.
- - The patients were treated with circumferential RFA (balloon) and had biopsies taken every few months. Some patients had repeat treatment and one patient also had an endoscopic mucosal resection (EMR).
- - One patient hadn’t completed the therapy yet, so his/her results weren’t available
- - 4/6 patients had complete resolution of their high grade squamous dysplasia
- - 2/6 patients were found to have squamous cell cancer at follow up and began chemoradiotherapy
- - One patient developed a stricture, which required several esophageal dilations and one patient had minor bleeding
So, this is a small pilot study that shows that RFA can be used to treat squamous dysplasia in patients who cannot be treated with surgery.
One other case report discussed use of RFA for early squamous cell cancer and high grade squamous dysplasia of the esophagus. One patient with an early (shallow) 3.5 cm squamous cell cancer of the esophagus was treated using the circumferential RFA balloon. The patient could not have surgery for treatment due to other medical issues. Follow up endoscopy with biopsies a few months later showed no evidence of cancer or squamous dysplasia. The patient did well and this may be an option for other patients in the future.
To summarize, at this time, RFA is not being used routinely for patients with squamous dysplasia or early squamous cell cancers of the esophagus. Early reports show some success, and there will likely be other research studies looking at this disease.
JM Dunn, S Thorpe, M Novelli, SG Bown, L Lovat Radiofrequency Ablation for the Treatment of Squamous High Grade Dysplasia of the Oesophagus- First Reported Series. Gastrointestinal Endoscopy, Volume 69, Issue 5, April 2009, Page AB255.
RE Pouw, JJ Gondrie, WL Curvers, CM Sondermeijer, FJ ten Kate, JJ Bergman Successful balloon-based radiofrequency ablation of a widespread early squamous cell carcinoma and high-grade dysplasia of the esophagus: a case report. Gastrointestinal Endoscopy, Volume 68, Issue 3, September 2008, Pages 537-541.