Radiofrequency ablation effective in preventing esophageal cancer, study finds

UK: In a new study conducted by Paul Wolfson and team, it was shown that Radiofrequency ablation (RFA) therapy is both effective and long-lasting in the prevention of esophageal cancer. The majority of therapy relapses occur early and may be effectively treated again. The findings of this study were published in the journal Gastrointestinal Endoscopy.

This study was conducted with the purpose to check long-term durability data on radiofrequency ablation's usefulness in preventing esophageal cancer in individuals with dysplastic Barrett's esophagus (BE) are inadequate.

This study collected data from 2,535 individuals with neoplasia (20% low-grade dysplasia, 54% high-grade dysplasia, 26% intramucosal carcinoma) and BE (mean length 5.2cm, range 1-20cm) who had RFA treatment in 28 UK institutions. Invasive cancer rates were assessed, and a comprehensive study of 1,175 patients was undertaken to determine clearance rates of dysplasia (CR-D) and intestinal metaplasia (CR-IM) within 2 years after initiating RFA therapy. Relapse rates and rates of return to CR-D (CR-D2) and CR-IM (CR-IM2) following further therapy were also carefully examined. The lack of dysplasia and intestinal metaplasia on biopsies collected during two successive endoscopies indicated the presence of CR-D and CR-IM.

The results of this study stated as follow:

1. The Kaplan Meier (KM) cancer rate ten years after commencing therapy was 4.1 percent, with a crude incidence rate of 0.52 per 100 patient-years.

2. After two years of treatment, the CR-D and CR-IM rates were 88 and 62.6%, respectively.

3. At 8 years, KM relapse rates were 5.9% for CR-D and 18.7% for CR-IM, with the majority occurring in the first two years.

4. Two years following retreatment, both could be effectively reversed with CR-D2 (63.4%) and CR-IM2 (70.0%). EMR before RFA raised the chance of rescue EMR from 17.2% to 41.7% but had no effect on CR-D, whereas rescue EMR after RFA lowered CR-D from 91.4% to 79.7% (X2 p0.001).

In conclusion, RFA treatment for dysplastic BE seems to be successful and long-lasting in the prevention of esophageal cancer.

Reference: 

Wolfson P, Ho KMA, Wilson A, McBain H, Hogan A, Lipman G, Dunn J, Haidry R; UK RFA Study Group, Novelli M, Olivo A, Lovat LB. Endoscopic eradication therapy for Barrett's Esophagus related neoplasia. A final 10 year report from the United Kingdom National Halo Radiofrequency Ablation Registry. Gastrointest Endosc. 2022 Feb 18:S0016-5107(22)00121-3. doi:10.1016/j.gie.2022.02.016. Epub ahead of print. PMID: 35189088.