13 april 2011: ik ben kanker-actueel aan het herzien en heb onderaan de resultaten van een recente Nederlandse fase III studie toegevoegd over behandelen van vroege slokdarmkanker met RFA en andere operatie technieken. En hier direct de resutlaten van een recentere studie van RFA voor slokdarmkanker. Daaronder de studie uit 2008
Gut 2010;59:A115; doi:10.1136/gut.2009.208983s
Copyright © 2010 BMJ Publishing Group Ltd & British Society of Gastroenterology.

Oesophagus posters

PWE-075 Endoscopic radiofrequency ablation for high-grade dysplasia or intramucosal cancer in Barrett's oesophagus – results from the first 100 patients enrolled in the UK HALO radiofrequency ablation registry

J M Dunn1, S Thorpe1, G M Fullarton2, H Smart3, I Penman4, P Patel5, R Willert6, M R Novelli7, M B Banks8, L B Lovat8

1 National Medical Laser Centre, University College London, London, UK
2 Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
3 Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
4 Department of Gastroenterology, Western General and Royal Infirmary, Edinburgh, Scotland, UK
5 Department of Gastroenterology, Southampton General Hospital, Southampton, UK
6 Department of Gastroenterology, Central Manchester University Hospital, Manchester, UK
7 Department of Pathology, University College London, UK
8 Gastroenterology, University College London Hospital, London, UK

Introduction: The incidences of Barrett's oesophagus (BE) and associated oesophageal adenocarcinoma are increasing rapidly in the UK. Radiofrequency ablation (RFA) with a circumferential balloon based device (CA) and endoscope-mounted focal ablation device (FA) are promising modalities for treating dysplasia arising in BE.

Aim: To determine the safety and efficacy of RFA for treating dysplastic BE in a UK patient cohort.

Study Design: Multicentre UK registry (seven teaching and private hospitals; treatment period from April 2007 to November 2009). Patients with histological evidence of dysplasia or intramucosal cancer (IMC) arising in BE confirmed by two specialist GI pathologists were included in the study. A prior endoscopic mucosal resection (EMR) was permitted, provided that residual dysplasia remained in the BE region for ablation. RFA was performed every 3 months with follow-up biopsy upon achieving either complete endoscopic eradication of BE or after four consecutive ablations. The primary endpoint was complete response for high-grade dysplasia (CR-HGD), dysplasia (CR-D) and intestinal metaplasia (CR-IM), defined as no biopsy showing each respective finding.

Results: A total of 106 patients (79% male, median age 69 years, interquartile range (IQR) 50–83 years) have been treated so far. Accrual rates now exceed 15 patients per quarter. 83 had HGD, 22 IMC, 1 LGD. Median length of BE was 6 cm (IQR 1–15 cm). 54% had prior EMR, 25% had previous photodynamic therapy (PDT) or argon plasma coagulation (APC).

42 patients have completed treatment with at least 1 follow-up biopsy session (median follow-up 4 months, IQR 2–24). Median number of treatments is 1 CA (IQR 0–3) and 1 FA (IQR 0–3). CR-HGD was achieved in 90% of patients, CR-D in 79% and CR-IM in 33%. There were eight new strictures, three mucosal injuries during RFA (1.5%) and one perforation (patient previously treated with PDT) (0.5%).

Conclusion: Reversal of IM is currently poor, but many of these patients have had multiple previous ablative therapies and may represent a particularly difficult group to treat. Despite this, radiofrequency ablation safely achieved a CR- HGD in 90% of patients treated within a UK multicentre registry. These data are similar to other registries.

 

24 mei 2008: Bron Wallstreet Journal
RFA - Radio Frequency Ablation blijkt voor slokdarmkanker - Barrett's esophagus - en voorstadia daarvan een zeer succesvolle aanpak. Uit een tussenevaluatie van een grote gerandomiseerde meerjarige studie verdeeld over meerdere ziekenhuizen in de Verenigde Staten blijkt dat maar liefst 74% na een jaar nog steeds vrij was van Barrett's esophagus en 85% vrij van dysplasia, een voorstadium van slokdarmkanker. Dit meldt de Wallstreet Journal naar aanleiding van een tussen evaluatie van een gerandomiseerde studie gepresenteerd op ASCO 2008. Hieronder het volledige artikel met video erbij hoe slokdarmkanker wordt behandeld met RFA techniek.
Esophageal Therapy You Can Stomach
May 20, 2008; Page D1

Got heartburn? Several times a week for five or more years? Then you're at increased risk for a form of esophageal cancer that, though rare, is the fastest-growing cancer in the U.S., particularly in white men over 50. It's also one of the most deadly, with a five-year survival rate of just 17%.

Doctors can sometimes see the cancer coming years earlier when acid reflux causes cells in the esophagus to mutate to become more like stomach tissue, a condition called Barrett's esophagus. In adenocarcinoma, the Barrett's cells keep mutating into cancer.

 

WSJ health columnist Melinda Beck reports that a new method to zap precancerous cells in the esophagus is showing tremendous promise.

 

The standard treatment for Barrett's has been to watch for precancerous changes called dysplasia, and in some cases remove the patient's esophagus. But a new outpatient procedure that lets doctors zap Barrett's tissue with radiofrequency ablation (RFA) is showing promise.

At a conference of gastroenterologists in San Diego on Monday, researchers presented interim results from a multi-center trial showing that among patients treated with RFA, 85% were free of dysplasia, and 74% were free of all signs of Barrett's, 12 months later. None of the treated patients progressed to high-grade dysplasia or cancer. In the control group, several patients got worse, and none was free of Barrett's.

Other studies showed that RFA caused few side effects and that genetic changes in the esophagus returned to normal afterward.

 

"It's way cool. It's far and away the most effective endoscopic treatment that we've ever had," says Nicholas Shaheen, director of the Center for Esophageal Disease and Swallowing at the University of North Carolina-Chapel Hill School of Medicine and the lead investigator.

The RFA procedure involves no incisions, but the patient is sedated. A gastroenterologist inserts a tiny camera, along with a sizing balloon, down the patient's esophagus. A second balloon delivers a short burst of energy that burns out the Barrett's tissue, which appears rough and red in contrast to healthy pink tissue. The technology, called the HALO Ablation System, is made by BÂRRX Medical Inc., a privately held company in Sunnyvale, Calif.

The RFA procedure is usually repeated a few months later, with a smaller HALO device. "It's like removing old wallpaper -- you do a big stripping and then go back and remove any bits that are left," says Charles Lightdale, a gastroenterologist at NewYork-Presbyterian Hospital/Columbia, who also consults for BÂRRX.

To date, about 16,000 RFA procedures have been performed since 2001; it's available at about 200 centers in the U.S., and covered by Medicare and most insurers. It's too soon to know whether the Barrett's will return in the long run. Patients are usually kept on acid-blocking drugs.

No one knows why adenocarcinoma of the esophagus is rising so fast -- up sixfold in the U.S. since 1975. It appears to be related to obesity, especially belly fat, which puts pressure on the abdomen. Another form of esophageal cancer, squamous cell, linked to alcohol and tobacco use, is declining in the U.S.

An estimated 3.3 million Americans have Barrett's. Only about 1 in every 200 of them will develop esophageal cancer. But people with high-grade dysplasia have a much higher risk.

For them, RFA appears to be a good alternative to an esophagectomy, a grueling operation that severely restricts eating. A big question now is whether people with earlier stages of Barrett's should be treated with RFA, which is still new and costly, or just watched with endoscopes and biopsies.

"This is very safe and effective therapy," says Dr. Shaheen, who gets no remuneration from BÂRRX. "But as we move from high-risk to lower-risk patients, the calculus changes."

Some patients are eager to eliminate the cancer risk. Louis Plzak, a retired thoracic surgeon from Philadelphia, had monitored his Barrett's for several years when he learned about RFA at a surgical conference and decided to have it done preventatively. "This will allow me to start living without the fear of Barrett's," says Dr. Plzak, age 74.

If you're having reflux several times a week, if you need medicine to control it or if you had it in the past, see a gastroenterologist. Chronic heartburn may stop once Barrett's sets in, since the mutated tissue isn't as sensitive to reflux. Controlling your weight will also help cut your risk of esophageal cancer.

Stapsgewijze radicale endoscopische operatie tegenover en/of samen met RFA bij beginnende slokdarmkanker blijkt succesvolle aanpak

Bron: GUT, jan. 2011

Gut doi:10.1136/gut.2010.229310

Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett's oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial

  1. Frederike G I van Vilsteren1,
  2. Roos E Pouw1,
  3. Stefan Seewald2,
  4. Lorenza Alvarez Herrero3,
  5. Carine M T Sondermeijer1,
  6. Mike Visser4,
  7. Fiebo J W ten Kate4,
  8. Karl C Yu Kim Teng2,
  9. Nib Soehendra2,
  10. Thomas Rösch2,
  11. Bas L A M Weusten3,
  12. Jacques J G H M Bergman1

+ Author Affiliations

  1. 1Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  3. 3Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands
  4. 4Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Jacques Bergman, Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; j.j.bergman@amc.uva.nl
  • Revised 5 November 2010
  • Accepted 30 November 2010
  • Published Online First 5 January 2011

Abstract

Objective After focal endoscopic resection (ER) of high-grade dysplasia (HGD) or early cancer (EC) in Barrett's oesophagus (BO), eradication of all remaining BO reduces the recurrence risk. The aim of this study was to compare the safety of stepwise radical ER (SRER) versus focal ER followed by radiofrequency ablation (RFA) for complete eradication of BO containing HGD/EC.

Methods A multicentre randomised clinical trial was carried out in three tertiary centres. Patients with BO ≤5 cm containing HGD/EC were randomised to SRER or ER/RFA. Patients in the SRER group underwent piecemeal ER of 50% of BO followed by serial ER. Patients in the ER/RFA group underwent focal ER for visible lesions followed by serial RFA. Follow-up endoscopy with biopsies (four-quadrant/2 cm BO) was performed at 6 and 12 months and then annually. The main outcome measures were: stenosis rate; complications; complete histological response for neoplasia (CR-neoplasia); and complete histological response for intestinal metaplasia (CR-IM).

Results CR-neoplasia was achieved in 25/25 (100%) SRER and in 21/22 (96%) ER/RFA patients. CR-IM was achieved in 23 (92%) SRER and 21 (96%) ER/RFA patients. The stenosis rate was significantly higher in SRER (88%) versus ER/RFA (14%; p<0.001), resulting in more therapeutic sessions in SRER (6 vs 3; p<0.001) due to dilations. After median 24 months follow-up, one SRER patient had recurrence of EC, requiring ER.

Conclusions In patients with BO ≤5 cm containing HGD/EC, SRER and ER/RFA achieved comparably high rates of CR-IM and CR-neoplasia. However, SRER was associated with a higher number of complications and therapeutic sessions. For these patients, a combined endoscopic approach of focal ER followed by RFA may thus be preferred over SRER.

Clinical trial number NTR1337.


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