Radiation therapy for loco-regionally recurrent esophageal cancer after surgery
Introduction
Loco-regional recurrence of esophageal cancer after surgery is one of the main types of treatment failure for this form of cancer [1], [3], [8]. Radiation therapy with or without chemotherapy seems to be effective for this type of cancer, since regression of the recurrent tumor has been obtained in a significant proportion of patients [7]. However, the outcome of radiation therapy and prognostic factors for loco-regional recurrence of esophageal cancer has not been studied extensively.
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Materials and methods
Between 1988 and 1997, a total of 33 esophageal cancer patients received radiation therapy for postoperative loco-regional recurrence at Tohoku University Hospital. All of the patients had received esophagectomy through the right thoracic and abdominal cavity with mediastinal and abdominal lymphadenectomy. All of the patients had also undergone an R0 resection. The stomach was used for the thoracic esophageal substitution.
The site of recurrence was the supraclavicular region in 14 patients, the
Overall survival
The survival periods of all patients are shown in Fig. 1. The median survival period was 7 months. The survival rates at 1, 2, and 3 years were 33, 15, and 12%, respectively.
Relapse rates
Relapse rates by type of recurrence are shown in Fig. 2. Loco-regional recurrence and distant metastasis developed in most of the patients. At 3 years after the radiation therapy, the loco-regional recurrence rate was 83% and the distant metastasis rate was 89%. Most of the recurrences developed within 2 years after
Discussion
The esophageal cancer patients with loco-regional recurrence in our series had a very poor prognosis. Raoul et al. [7] reported the results of chemoradiation for postoperative recurrence (mainly loco-regional) of esophageal cancer. In their series, the survival rates at 1, 2, and 3 years were 47.1, 17.1, and 4.3%, respectively, which are fairly similar to the survival rates in our series. On the other hand, an objective response was obtained in 91% of the patients, and palliation of symptoms
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