Outcome and Treatment Strategy for Mid‐ and Lower‐Thoracic Esophageal Cancer Recurring Locally in the Lymph Nodes of the Neck

Abstract

The aim of the present study was to assess the outcome of treatment for patients with recurrent mid- and lower-thoracic esophageal cancers in whom recurrence was localized to the lymph nodes of the neck, and to determine the best strategy for further treatment. Between 1989 and 2001, 270 patients with mid- and lower-thoracic esophageal cancer underwent curative esophagectomy; 90 of those patients had a cancer recurrence. Our focus was on lymph node recurrence, especially when the recurrent cancers were localized to the lymph nodes in the neck. The outcomes of those patients and the efficacy of the strategies used to treat the recurrent cancers were determined. In 43 patients (48%), recurrent cancer initially appeared in the lymph nodes. Among the 43 patients, 15 (35%) had localized neck recurrence. The time between tumor recurrence and death among the 15 patients with localized neck recurrence was significantly longer than among the 28 patients with other recurrence patterns. In addition, 15 patients underwent lymph node resection, while 28 patients were treated non-surgically. The time between tumor recurrence and death was significantly longer in patients treated surgically. Of the 15 patients in whom recurrence affected the neck lymph nodes only, 10 (67%) were treated surgically; their 2-year survival rate after recurrence was 45%. The outcomes of recurrent esophageal cancers localized to the lymph nodes of the neck were better than those seen with other recurrence patterns, and salvage resection followed by chemoradiation therapy would seem to be indicated for those patients.

Patterns and Outcomes of Recurrent Esophageal Cancer After Curative Esophagectomy

“…Lymph node, distant organ, and local recurrence were observed in 22-67, 31-55, and 3-8% of patients, respectively [3,9,10,[12][13][14][15]. In the present study, we also found that 88.6% of recurrences happen within 2 years of curative esophagectomy.…”

Molecular profiles of the mouse postnatal development of the esophageal epithelium showing delayed growth start

“…However, our finding provides a new experimental model for studies on self-renewal of esophageal epithelial stem cells. Esophageal squamous cell carcinoma has a poor prognosis because of frequent metastasis to the lymph nodes and lungs (14)(15)(16). There is no radical therapy for patients with metastases.…”

Long-Term Survival After Salvage Resection of Recurrent Esophageal Cancer with Anterior Mediastinal Lymph Node Involvement: Report of a Case

“…5 On the other hand, a few patients with recurrence in only the neck lymph nodes, including some of our patients, underwent salvage resection followed by acceptable survival times. 6 We think that the nature of the cancer recurring only in the neck lymph nodes or anterior mediastinal lymph nodes differs from that of other recurrent forms, and this difference makes it more amenable to treatment. 6 In our experience, we have treated anterior mediastinal lymph node recurrence by salvage resection followed by chemoradiotherapy in two patients who survived long term as a result.…”

“…6 We think that the nature of the cancer recurring only in the neck lymph nodes or anterior mediastinal lymph nodes differs from that of other recurrent forms, and this difference makes it more amenable to treatment. 6 In our experience, we have treated anterior mediastinal lymph node recurrence by salvage resection followed by chemoradiotherapy in two patients who survived long term as a result. However, this remains a hypothesis to be tested, perhaps by examining the relevant signaling pathways in primary and recurrent cancer cells.…”