Elsevier

Radiotherapy and Oncology

Volume 61, Issue 2, November 2001, Pages 165-168
Radiotherapy and Oncology

Radiation therapy for loco-regionally recurrent esophageal cancer after surgery

https://doi.org/10.1016/S0167-8140(01)00392-9Get rights and content

Abstract

Purpose: To evaluate the treatment outcome of radiation therapy for 33 loco-regionally recurrent esophageal cancer patients.

Methods: Between 1988 and 1997, 33 patients with loco-regional recurrence of esophageal cancer after curative surgery received radiation therapy at an average total dose of 61 Gy. The site of recurrence was the supraclavicular region in 14 patients, the mediastinal region in 13 patients, and both the supraclavicular and mediastinal regions in six patients. If patients had ether distant metastasis or malignant pleural effusion, they were excluded from analysis. Patients who received prophylactic postoperative irradiation were also excluded from analysis.

Results: The median survival period was 7 months. The survival rates at 1, 2, and 3 years were 33, 15, and 12%, respectively. In univariate analysis, patients with a short time interval between surgery and recurrence (P=0.0098) and patients with recurrence in both the supraclavicular and mediastinal regions (P=0.036) had a worse prognosis. In multivariate analysis, the time interval between surgery and recurrence (P<0.001) and age (worse prognosis in younger patients, P=0.019) were the significant prognostic factors. Complete or partial responses were observed in nine (27%) and 21 (64%) of the patients, respectively. Changes in clinical symptoms, such as dysphagia, chest pain and back pain, could be evaluated in 11 patients, and improvement in symptoms was obtained in eight (73%) patients.

Conclusions: The prognosis of patients who received radiation therapy for postoperative loco-regional recurrence of esophageal cancer is poor. However, there is symptomatic relief in a significant proportion of such patients, and long-term survival is possible in some patients.

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.

Section snippets

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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