Salvage concurrent radio-chemotherapy for post-operative local recurrence of squamous-cell esophageal cancer

Abstract

PurposeTo evaluate the treatment outcome of salvage concurrent radio-chemotherapy for patients with loco-recurrent esophageal cancer after surgery.Methods50 patients with loco-recurrent squamous-cell cancer after curative esophagectomy were retrospectively analyzed. Patients were treated with radiotherapy (median 60 Gy) combined with chemotherapy consisting of either 5-fluorouracil (5-FU) plus cisplatin (DDP) (R-FP group) or paclitaxel plus DDP (R-TP group).ResultsThe median follow-up period was 16.0 months. The 1-year and 3-year survival rates were 56% and 14%, respectively. The median progression-free survival (PFS) and overall survival (OS) time was 9.8 and 13.3 months respectively. There was no statistical significance of the PFS of the two groups. The OS (median 16.3 months) in the R-TP group was superior to that in the R-FP group (median: 9.8 months) (p = 0.012). Among the patients who had received ≥60 Gy irradiation dose, the median PFS (10.6 months) and OS (16.3 months) were significantly superior to the PFS (8.7 months) and OS (11.3 months) among those patients did not (all p < 0.05). Grade 3 treatment-related gastritis were observed in 6 (27.3%) and 7 (25%) patients in the R-FP and R-TP group respectively. By univariate survival analysis, the age (<60 years), TP regimen and higher irradiation dose might improve the OS of such patients in present study.ConclusionsFor those patients with post-operative loco-recurrent squamous-cell esophageal carcinoma, radiotherapy combined with either FP or TP regimen chemotherapy was an effective salvage treatment. Younger age, treatment with the TP regimen and an irradiation dose ≥60 Gy might improve the patients’ treatment outcome.

Comparison and Prognostic Analysis of Adjuvant Radiotherapy versus Salvage Radiotherapy for Treatment of Radically Resected Locally Advanced Esophageal Squamous Cell Carcinoma

“…Indeed, similar to our findings, some recent studies report that the median OS of salvage radiotherapy for locoregional recurrence after curative surgery can reach 9–21 months [3, 6, 7]. Therefore, once the tumor relapses, salvage radiation with a radical dose might be a promising treatment strategy for improving tumor remission and survival.…”

Risk Factors for Local Recurrence and Optimal Length of Esophagectomy in Esophageal Squamous Cell Carcinoma

“…Several studies reported LR is a poor prognostic factor for survival in patients with recurrence [8,9]. The survival after radiation therapy for LR is poor, ranging from 7 to 21 months [5,10]. In our study, the postrecurrence survival in the patients was very poor, with a median survival of 7 months, which was comparable to previous studies.…”

“…Recurrence after esophagectomy showed very poor prognosis despite treatment [4,5]. The most common locations of recurrence in esophageal cancer are regional and distant recurrences; therefore, the importance of lymphadenectomy and multimodality treatment has been emphasized [6,7].…”

Diagnostic Performance of 18F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis

“…The key reason to refrain from routine imaging is the limited amount of adequate therapeutic options when recurrence is detected. Current treatment options for recurrent disease consist of salvage chemoradiotherapy, which is associated with symptomatic relief and improved survival rates (32,33). Furthermore, recent experimental studies have demonstrated that reoperation for selected cases of localized recurrence or solitary recurrence in lymph nodes, lungs, and subcutaneous lesions is safe and may improve survival (34)(35)(36)(37)(38).…”