Among patients with the condition known as Barrett esophagus, treatment of abnormal cells with radiofrequency ablation resulted in a reduced risk of progression to cancer, according to a European study.
In the last three decades, the incidence of esophageal cancer has increased more rapidly than other cancers in the Western world, according to background information in the study, which was published in the March 26 issue of the Journal of the American Medical Association. This type of cancer often originates from Barrett esophagus, which involves abnormal changes in the cells of the lower portion of the esophagus, a complication of severe chronic gastrointestinal reflux disease.
Radiofrequency ablation the use of heat applied through an endoscope to destroy cells is an effective treatment for Barrett esophagus. But its benefits largely have been shown in patients with high-grade dysplasia, meaning precancerous changes that are more likely to progress quickly to cancer.
The question of whether radiofrequency ablation is effective for patients with Barrett esophagus and low-grade dysplasia, meaning precancerous changes that progress more slowly to cancer, is a clinically important question because 25% to 40% of patients with Barrett esophagus are diagnosed with low-grade dysplasia at some point during follow-up, the authors wrote.
Study methodology and results
K. Nadine Phoa, MD, of the University of Amsterdam, the Netherlands, and colleagues randomly assigned 136 patients with a confirmed diagnosis of Barrett esophagus and low-grade dysplasia to radiofrequency ablation, with a maximum of five sessions, or endoscopic surveillance, which was the control group. The researchers assessed the rate of progression to high-grade dysplasia and esophageal cancer. The study was conducted at nine European sites between June 2007 and June 2011, with follow-up through May 2013.
The researchers found that ablation was associated with reduced absolute risk of progression to high-grade dysplasia or cancer of 25% (1.5% vs. 26.5% among patients in the control group) and a reduced absolute risk of progression to cancer of 7.4% (1.5% vs. 8.8%). Complete eradication of dysplasia occurred and persisted in the majority of patients in the ablation group.
The trial was terminated early due to the superiority of ablation for the primary outcome and concerns about patient safety should the trial continue.
In this multicenter, randomized trial of radiofrequency ablation versus surveillance in patients with Barrett esophagus and a confirmed histological diagnosis of low-grade dysplasia, ablation substantially reduced [tumor] progression to high-grade dysplasia and adenocarcinoma over three years of follow-up, the authors wrote. Patients with a confirmed diagnosis of low-grade dysplasia should therefore be considered for ablation therapy.
In an accompanying editorial, Klaus Monkemuller, MD, PhD, FASGE, of the University of Alabama at Birmingham, wrote: The clinical trial by Phoa et al provides important evidence to support the use of radiofrequency ablation not only for patients with high-grade dysplasia and early cancer, but also for carefully selected patients [via screening and testing] with Barrett esophagus and confirmed low-grade dysplasia. A proactive endoscopic approach to eliminate dysplasia may result in reduced morbidity and mortality related to the progression of this disease.
Study abstract: http://jama.jamanetwork.com/article.aspx?articleid=1849991