Treatment strategies in recurrent esophageal or junctional cancer

Abstract

Little evidence is available about survival rates in patients with recurrent disease after potentially curative surgery for esophageal or junctional cancer. Only in limited occasions, potentially curative salvage strategies are available. The aim of this study is to analyze survival rates and patterns of dissemination, and to identify independent prognostic factors in a consecutive series of patients who develop recurrent esophageal or junctional cancer. Between 1994 and 2015, patients who developed disease recurrence after neoadjuvant chemo(radio)therapy followed by radical esophagectomy for esophageal or junctional cancer were retrospectively analyzed. The Kaplan-Meier estimates were performed to calculate and compare overall survival between patients with different patterns of dissemination and to compare between different treatment strategies. Furthermore, univariate and multivariate Cox-regression analyses were performed to identify independent prognostic factors for post recurrence survival. In this study, we included 219 patients. The median overall survival of all included patients was 3.2 months (range: 0.0-101.1 months). The median overall survival in patients with exclusively locoregional recurrence (n = 23, 10.8%) was 4.9 months (range: 0.1- 55.6) and 2.9 months (range: 0.0-101.1) in patients who had distant metastases (n = 189, 89.2%), P = 0.003. Patients who received treatment aimed at complete tumor eradication (n = 28, 13.7%) had a median overall survival of 13.6 months (range: 1.1-101.1) and palliative treated patients (n = 94, 46.1%) of 4.7 months (range: 0.3-25.6), P < 0.001. In a selected group of patients survival of more than 20 months was achieved. Univariate and multivariate Cox-regression analysis showed that a higher age at the diagnosis of recurrent disease (hazard ratio: 1.087, P ≤ 0.001), an irradical resection of the primary tumor (hazard ratio: 3.355, P = < 0.001), the number of positive lymph nodes after neoadjuvant therapy (hazard ratios: ypN2 = 1.724 (P = 0.024) and ypN3 = 2.082 (P = 0.028) and the presence of a single hematogenous distant metastases (hazard ratio: 2.281, P = 0.003) or more than one hematogenous distant metastasis (hazard ratio: 2.385, P = 0.005) were associated with a shorter postrecurrence survival. The prognosis of patients who develop recurrent esophageal or junctional cancer is poor. In a selected group of patients however relatively long survival can be achieved. This offers new perspectives to improve treatment strategies and survival rates.

Value of regular endosonography and [18F]fluorodeoxyglucose PET–CT after surgery for gastro-oesophageal junction, stomach or pancreatic cancer

“…In the present study, isolated locoregional recurrence was found in 13 of 42 patients (31 per cent) who were regularly followed up with EUS and PET–CT, a figure slightly higher than the 23 per cent reported elsewhere 6 , probably related to the more frequent examinations in the present study. In a recent study of oesophageal and GOJ cancers 32 , in which patients underwent imaging only if recurrence was suspected clinically, isolated local recurrence was found in only 10 per cent. It may be that this pattern of recurrence is not necessarily symptomatic and the time window for its detection can easily be missed.…”

A population-based study in resected esophageal or gastroesophageal junction cancer aligned with CheckMate 577

“…An earlier diagnosis, however, may not have a large effect on the prognosis, as treatment options after recurrence are limited and postrecurrence survival is poor. 23 , 24 To assess the true value of the addition of nivolumab in the adjuvant setting, overall survival data are eagerly awaited.…”

Arterial Infusion Chemotherapy for Neoplastic Esophagogastric Anastomotic Strictures After Esophagectomy

“…Yuichiro and colleagues ( 22 ) reported that the median duration of survival of patients suffering from esophageal cancer with local recurrence after surgery was ~178 days. According to Butterer and colleagues, the median overall survival of patients with local recurrence was 4.9 months, that of patients with distant metastasis was 2.9 months, and that of all patients was 3.2 months ( 23 ).…”