Radiofrequency Ablation Reduces Cancer Risk in Patients With Barrett Esophagus

Barrett
Researchers examined the long-term effectiveness of radiofrequency ablation therapy for preventing esophageal adenocarcinoma in Barrett esophagus.

Radiofrequency ablation (RFA) treatment is effective for preventing esophageal adenocarcinoma in patients with dysplastic Barrett esophagus (BE), according to study results published in Gastrointestinal Endoscopy.

Researchers sought to determine the 10-year cancer progression rate in patients who had endoscopic eradication therapy (EET) for BE.

Using data from the UK National HALO Radiofrequency Ablation Registry, from January 2008 to December 2018, researchers identified patients for inclusion. All patients (N=2535) enrolled, from April 2008 to December 2018, had histologically confirmed low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal cancer (IMC) before beginning EET.

Researchers used a 24-month cutoff from initiation of therapy and calculated the time to achieve complete remission of dysplasia (CR-D) and complete remission of intestinal metaplasia (CR-IM) after relapse, defined as CR-D2 and CR-IM2, respectively. Researchers also examined the risk for invasive cancer.

Cancer outcomes were reported for patients who had 18,371 procedures at 28 sites. CR-D and CR-IM rates and relapse rates were reported for 1175 patients (mean age, 67.2±9.4 years; men, 83%; White, 93%).

The Kaplan-Meier (KM) rate of invasive cancer in the entire cohort was 0.5%, 1.2%, and 4.1% at 1 year, 2 years, and 10 years after initiation of RFA therapy, respectively.

During the follow-up, 41 patients had invasive cancer, of whom 22 developed invasive cancer within 18 months of initiating EET. In addition, 11 of the 41 patients initially achieved CR-D at 2 consecutive endoscopies but then relapsed to invasive cancer after a median of 3.4 years (IQR, 1.9-4). The other 30 patients did not achieve CR-D and had invasive cancer after a median of 433.5 days (IQR, 310-765).

The follow-up in the full cohort was 7856 patient-years, with a crude incidence rate of .52 per 100 patient-years. The crude incidence rate in patients with LGD was .20 per 100 patient-years, and the combined crude incidence rate in patients with HGD and IMC was .63 per 100 patient-years (X2; P =.015).

At 2 years after EET initiation, 88.0% of patients achieved CR-D, with rates of 87.2% for LGD, 89.1% for HGD, and 86.4% for IMC (log rank P =not significant).

The KM relapse rate from CR-D for the full cohort was 1.1% at 1 year, 2.7% at 2 years, and 5.9% at 8 years. No differences occurred by histologic subtype, with a rate of 0.5% at 1 year for participants with LGD, 1.5% for those with HGD, and 0.7% for those with IMC. At 2 years, the relapse rates were 1.2%, 3.5%, and 2.0%, respectively, and at 8 years the rates were 2.2%, 6.8%, and 6.3%, respectively.

Among the patients who were successfully treated initially and then relapsed to dysplasia, CR-D2 was achieved in 54.4% after 1 year and 63.4% after 2 years.

Within 2 years of therapy initiation, 62.7% of patients achieved CR-IM. The relapse rate from CR-IM was 4.2% at 1 year, 10.1% at 2 years, and 18.7% at 8 years. In the 74 patients who relapsed from CR-IM, the CR-IM2 rate after additional treatment was 46.5% after 1 year and 70.0% after 2 years.

Primary endoscopic mucosal resection (EMR) was conducted in 646 patients (55.0%). At 2 years, the CR-D rate was 87.6% vs 88.1% (X2; P =.80) for patients without primary EMR. However, rescue therapy was more likely if an EMR had been performed before RFA initiation (41.2% vs 17.2%; X2; P <.00001).

Rescue therapy during or after CR-D was required by 30.6% of patients and was primarily EMR (n=351); 79.7% of patients achieved CR-D. Compared with 69.4% of patients who did not undergo rescue therapy, the overall CR-D rate was 91.4%. CR-D was significantly lower among those who needed rescue therapy (X2; P < .001).

The researchers noted that their findings are limited because patients were followed by their recruiting site, and about 25% of them were excluded from the detailed analysis owing to inadequate follow-up.

“We have shown long-term benefit of EET in reducing rates of invasive cancer in a large cohort of patients, with RFA alone achieving excellent results in selected patients,” the study authors wrote. “Durability was high, with most relapses occurring shortly after completion of therapy and being treatable with the same modality. EET with RFA is now firmly established as the primary therapy for dysplastic BE.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Wolfson P, Ho KMA, Wilson A, et al. Endoscopic eradication therapy for Barrett’s esophagus–related neoplasia: a final 10-year report from the UK National HALO Radiofrequency Ablation Registry. Gastrointest Endosc. 2022;96(2):223-233. doi:10.1016/j.gie.2022.02.016