Re-irradiation of locoregional esophageal cancer recurrence following definitive chemoradiotherapy: A report of 6 cases

Abstract

Abstract. There is currently no consensus on salvage therapy for recurrent esophageal cancer. Salvage surgery is a well-established option for attaining long-term survival; however, it is associated with a high risk of perioperative morbidity and mortality. A total of 6 patients who underwent re-irradiation for recurrence of locoregional esophageal cancer following definitive chemoradiotherapy were investigated. The median interval between initial radiotherapy and re-irradiation was 17.4 months (range, 6.4-59.2 months). Re-irradiation salvage therapy was mostly administered with concurrent chemotherapy, which consisted of several cycles of nedaplatin on day 1 and oral S-1 administration on days 1-14. The median survival after re-irradiation was 13.6 months (range, 1.9-33.3 months). A total of 3 patients who completed hyperfractionated radiation therapy survived for >1 year. One patient has had no signs of recurrence or late radiation toxicity for >2 years. Severe acute hematological adverse events (AEs) occurred in 3 patients, including 1 case of grade 4 leukopenia. One severe late AE occurred in 1 patient, who developed grade 3 dysphagia and became permanently dependent on percutaneous endoscopic gastrostomy tube feeding. Salvage radiotherapy is considered to be a good treatment option for inoperable locoregional recurrent esophageal cancer. The results of the present study demonstrated that re-irradiation, with or without chemotherapy, for recurrent esophageal carcinoma after definitive chemoradiotherapy was tolerable and yielded reasonably satisfactory results.

Increased dose of re-irradiation therapy or combined chemotherapy to improve survival of local recurrent esophageal squamous cell carcinoma after radiotherapy

“…In subgroup analysis, our results showed that chemotherapy combined with radiotherapy could increase survival rate. In the LD group, the median survival time for chemoradiotherapy was 14 months, which was consistent with the results reported by Katano et al [6]. However, in the HD group, chemoradiotherapy did not show better e cacy than radiotherapy alone, and other studies have reported the same [17].…”

“…reported that the 1-, 2-and 3-year survival rates of 36 LRESCC patients receiving re-irradiation with concurrent chemotherapy (paclitaxel + cisplatin) were 51.7%, 21.4% and 12.2%, respectively [4]. Katano et al reported that the median survival time of six patients who underwent concurrent chemotherapy with nedaplatin and tegafur with re-radiotherapy was 13.6 months [6]. As of now, the role of chemotherapy in re-radiotherapy for recurrent ESCC is still unclear.…”

“…In addition, brosis of the tissue surrounding the tumor bed after radiotherapy increases the di culty of surgery and perioperative risk. Therefore, even carefully selected patients should be cautiously considered for surgery [5,6].…”

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.…”

“…Surgery plays an important role in achieving locoregional control in patients with LR esophageal carcinoma [8] but salvage esophagectomy may cause serious surgery-related complication and hospital mortality. CRT has curative potential for LR esophageal squamous cell carcinoma (ESCC) patients, but the clinical bene t and safety is not demonstrated very well due to the small number of cases [9][10][11][12][13][14][15]. In this study, we retrospectively analyzed the e cacy and toxicity of re-irradiation (re-RT) in patients with LR after radical radiotherapy or postoperative adjuvant radiotherapy on a relative large sample.…”