Comparison of salvage chemoradiation versus salvage surgery for recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy or radiotherapy alone

Abstract

A consensus treatment strategy for esophageal squamous cell carcinoma (ESCC) patients who recur after definitive radiochemotherapy/radiotherapy has not been established. This study compared the outcomes in ESCC patients who underwent salvage surgery, salvage chemoradiation (CRT) or best supportive care (BSC) for local recurrence. Ninety-five patients with clinical stage I to III ESCC who had completely responded to the initial definitive radiochemotherapy or radiotherapy alone and developed local recurrence were enrolled in this study. Fifty-one of them received salvage esophagectomy, and R0 resection was performed in 41 patients, 36 underwent salvage CRT, and the remaining eight patients received BSC only. The 5-year overall survival was 4.6% for the 87 patients receiving salvage surgery or CRT, while all patients in the BSC group died within 12.0 months, the difference was statistically significant (P = 0.018). The 1-, 3-, 5-year survival rates in the salvage surgery and salvage CRT groups were 45.1%, 20.0%, 6.9% and 51.7%, 12.2%, 3.1%, respectively, there was no difference of overall survival between the two groups (P = 0.697). Patients also presented with lymph node relapse had inferior survival compared to those with isolated local tumor recurrence after salvage therapy. In the salvage surgery group, infections occurred in eight patients, and three developed anastomotic leakage. In the salvage CRT group, grade 2-4 esophagitis and radiation pneumonitis was observed in 19 and 3 patients, respectively. Seven patients (19.4%) developed esophagotracheal fistula or esophageal perforation. This study of salvage CRT versus salvage surgery for recurrent ESCC after definitive radiochemotherapy or radiotherapy alone did not demonstrate a statistically significant survival difference, but the frequency of complications including esophagotracheal fistula and esophageal perforation following salvage CRT was high.

Systematic review and meta-analysis on the significance of salvage esophagectomy for persistent or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy

“…One of these was a two‐arm study that compared salvage esophagectomy versus second‐line CRT. The other three were three‐arm studies. Chao et al .…”

“…compared survival between salvage esophagectomy and second‐line CRT, and compared perioperative morbidity and mortality between salvage esophagectomy and planned esophagectomy after conventional neoadjuvant CRT . Additionally, two studies consisted of three groups: salvage esophagectomy, second‐line CRT, and best supportive care. In the present meta‐analysis, the three‐armed studies were treated as two‐armed studies that compared salvage esophagectomy and second‐line CRT, and best supportive care group was discarded.…”

“…Overall survival calculated from the day of salvage treatment to the day of death or last follow‐up was reported in all four studies. The reported 3‐year overall survival rates in salvage surgery group were 17%, 58%, and 20%, and those in second‐line CRT group were 0% and 12.2% . One study reported 5‐year overall survival rates, and showed that in salvage surgery group survival rate was 25.4% and in second‐line CRT group 0% .…”

Clinical analyses on salvage lymphadenectomy through cervical incision for patients with cervical and cervicothoracic recurrences after esophagectomy

“…The strategy for locoregional recurrences had not been completely established yet (4)(5)(6). Usually, patients with locoregional recurrences were thought to have a poor prognosis.…”

“…Despite the efforts of extended lymphadenectomy, locoregional recurrences are often observed (2,3). The strategy of salvage therapy for patients with locoregional recurrences has not been established completely (4)(5)(6). In our center, for patients with cervical and cervicothoracic recurrences, salvage lymphadenectomy though cervical incision has been performed for years (7)(8)(9).…”