Evaluating the optimal re-irradiation dose for locally recurrent esophageal squamous cell carcinoma after definitive radiotherapy

Abstract

BackgroundRe-irradiation (re-RT) has the active effect of relieving clinical symptoms and prolonging the survival of patients with recurrent esophageal squamous cell carcinoma (ESCC). However, the optimal re-RT dose is still uncertain. Here, we analyzed the prognostic factors associated with survival and explored the optimal re-RT dose for patients with recurrent ESCC following definitive radiotherapy.Patients and methodsThe data of 47 patients with recurrent ESCC who were retreated between 2010 and 2014 were retrospectively analyzed. All patients received a radiation dose > 50 Gy during the primary treatment. The median time to recurrence after primary radiotherapy was 26 months (range 6–120 months). All patients had in-field recurrence in the esophagus. Recurrence within the local site was observed in 37 patients (78.7%), and recurrence in both the local site and regional nodes were observed in 10 patients (21.3%). All patients received 3D conformal re-RT with a median dose of 58 Gy (range 26–64 Gy). Chemotherapy was sequentially used in 27.7% of the patients. Survival curves were constructed according to the Kaplan-Meier method and were compared by log-rank tests. The factors predictive of survival were identified with univariate and multivariate analyses.ResultsDysphagia relief after re-RT was achieved in 20 of the 35 symptomatic patients (57.1%). The median survival time (MST) of all patients was 17 months, and the 1-, 2-, 3- and 5-year overall survival (OS) rates were 72.3, 25.5, 17.0 and 2.1%, respectively. In the univariate analysis, an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0–1 (P = 0.014), recurrence at the local site (P = 0.048), time to recurrence ≥24 months (P = 0.006) and re-RT dose ≥50 Gy (P < 0.001) were associated with favorable OS. In the multivariate analysis, only re-RT dose was an independent factor for OS (P = 0.007). Severe complications were observed in 7 patients, two of whom received a re-RT dose > 60 Gy.ConclusionOur results demonstrated that patients with recurrent ESCC following definitive radiotherapy had unfavorable OS. Re-RT could be considered a feasible and effective treatment modality. A re-RT dose > 50 Gy could improve the survival outcomes, and a dose > 60 Gy should be administered with caution due to the risk of severe complications.

Efficacy and toxicity of re-irradiation for esophageal cancer patients with locoregional recurrence: a retrospective analysis

“…The 5-years OS rate was 32.1% in salvage radiotherapy patients, and the median survival time was 39.0 months, which is longer than those reported in other studies [ 13 , 14 ]. The median ARS was 13.0 months (range 3–168 months), which was similar to the results of previous studies [ 12 – 17 , 29 ]. Therefore, further research is needed to improve the survival time after recurrence.…”

“…Re-irradiation has been successfully used in many recurrent tumors of various sites with the development of radiotherapy techniques, such as head and neck cancer [ 7 , 22 ], high grade glioma [ 23 ], lung cancer [ 24 ], intracranial germ-cell tumors [ 25 ], rectal cancer [ 26 , 27 ] and paediatric tumor [ 28 ] with encouraging results. Several small size retrospective studies reported the outcome of re-RT of LR for ESCC patients received RT [ 14 , 17 , 29 ]. The only prospective study reported that re-RT for oligo-recurrence in lymph nodes from esophageal cancer treated by definitive RT or by surgery with additional RT might be acceptable but unsatisfactory [ 15 ].…”

Efficacy and Toxicity of Re-irradiation for Esophageal Cancer Patients with Locoregional Recurrence: a retrospective analysis

“…The 5-years OS rate was 32.1% in salvage radiotherapy patients, and the median survival time was 39.0 months, which is longer than those reported in other studies [12,13]. The median ARS was 13.0 months (range 3-168 months), which was similar to the results of previous studies [11][12][13][14][15]26]. Therefore, further research is needed to improve the survival time after recurrence.…”

“…Re-irradiation has been successfully used in many recurrent tumors of various sites with the development of radiotherapy techniques, such as head and neck cancer [7,19], high grade glioma [20], lung cancer [21], intracranial germ-cell tumors [22], rectal cancer [23,24] and paediatric tumor [25] with encouraging results. Several small size studies reported the outcome of re-RT of LR for ESCC patients received RT [13,15,26]. In our present study, we found that there was a signi cant increase in OS for patients who received re-RT.…”

Photodynamic Therapy Using Talaporfin Sodium for Local Failure after Chemoradiotherapy or Radiotherapy for Esophageal Cancer: A Single Center Experience

“…To date, the aging of population has been progressing and elderly patients with esophageal cancer are more likely to be treated with CRT or RT alone, instead of surgery, for comorbidities and treatment risks [29,30]. Salvage PDT is reported to be a safer and more effective treatment option than other minimally invasive treatments such as re-irradiation or endoluminal brachytherapy in elderly patients [31,32]. Finally, we hope that salvage PDT using talaporfin sodium will be recognized as a promising salvage treatment for esophageal cancer with local failure after CRT and function as a treatment of choice in the future.…”