AbstractObjective To evaluate the role of salvage radiotherapy in the re-treatment of patients with regional lymph node oligo-recurrence after radical surgery for esophageal squamous cell carcinoma. Methods Clinical data of patients diagnosed with thoracic esophageal squamous cell carcinoma treated with radical surgery and developed regional lymph node oligo-recurrence (n=1-3) from January 2013 to January 2016 were retrospectively analyzed. A total of 74 cases with intact clinical data were extracted for analysis. The survival analysis was performed by Kaplan-Meier method. Group comparison was conducted by Log-rank method. Results The median overall survival (OS) after recurrence was 9(2.5-43) months, and the median progression-free survival time (PFS) was 4(1-33) months. There were 47 cases in the salvage radiotherapy group and 27 cases in the non-radiotherapy group, and the Objective response rates were 77%(36/47) and 30%(8/27), respectively. Patients in the salvage radiotherapy group had better OS (P=0.042) and PFS (P=0.01) compared with their counterparts in the non-radiotherapy group. Among the patients who received salvage radiotherapy, involved field irradiation and elective nodal irradiation yielded similar OS (P=0.963) and PFS (P=0.599), and patients treated an irradiation dose ≥ 60Gy had better OS (P=0.001) and PFS (P=0.001) compared with those with dose< 60Gy. Conclusions Local salvage radiotherapy is an effective treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after radical surgery. Salvage radiotherapy has better OS and PFS compared with non-radiotherapy. Prospective clinical studies should be carried out to standardize the target and dose of radiotherapy, and to further clarify the effect of radiotherapy.
Fund:Fund programs:National Natural Science Foundation of China (81372436);Special Funds for Science and Technology Research and Development of Henan Province (182106000062);Project of Tackling Key Problems in Medical Science and Technology of Henan Province (2018020502)
Corresponding Authors:
Ge Hong, Email:gehong666@126.com
Cite this article:
Fan Chengcheng,Ge Hong,Ye Ke et al. The role of salvage radiotherapy in re-treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after surgery[J]. Chinese Journal of Radiation Oncology, 2020, 29(5): 332-336.
Fan Chengcheng,Ge Hong,Ye Ke et al. The role of salvage radiotherapy in re-treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after surgery[J]. Chinese Journal of Radiation Oncology, 2020, 29(5): 332-336.
[1] Bhansali MS, Fujita H, Kakegawa T, et al. Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus[J]. World J Surg, 1997, 21(3):275-281. DOI:10.1007/s002689900228.
[2] Collard JM, Otte JB, Reynaert MS, et al. Extensive lymph node clearance for cancer of the esophagus or cardia:merits and limits in reference to 5-year absolute survival[J]. Hepatogastroenterology, 1995, 42(5):619-627.
[3] Jingu K, Umezawa R, Yamamoto T, et al. Elective nodal irradiation is not necessary in chemoradiotherapy for postoperative loco-regional recurrent esophageal cancer[J]. Jpn J Clin Oncol, 2017, 47(3):200-205. DOI:10.1093/jjco/hyw195.
[4] Yamashita H, Jingu K, Niibe Y, et al. Definitive salvage radiation therapy and chemoradiation therapy for lymph node oligo-recurrence of esophageal cancer:a Japanese multi-institutional study of 237 patients[J]. Radiat Oncol, 2017, 12(1):38. DOI:10.1186/s13014-017-0780-5.
[5] Shioyama Y, Nakamura K, Ohga S, et al. Radiation therapy for recurrent esophageal cancer after surgery:clinical results and prognostic factors[J]. Jpn J Clin Oncol, 2007, 37(12):918-923. DOI:10.1093/jjco/hym138.
[6] Zhang J, Peng F, Li N, et al. Salvage concurrent radio-chemotherapy for post-operative local recurrence of squamous-cell esophageal cancer[J]. Radiat Oncol, 2012, 7(1):93. DOI:10.1186/1748-717X-7-93.
[7] Parry K, Visser E, van Rossum PS, et al. Prognosis and treatment after diagnosis of recurrent esophageal carcinoma following esophagectomy with curative intent[J]. Ann Surg Oncol, 2015, 22(Suppl 3):S1292-S1300. DOI:10.1245/s10434-015-4840-5.
[8] Nemoto K, Ariga H, Kakuto Y, et al. Radiation therapy for loco-regionally recurrent esophageal cancer after surgery[J]. Radiother Oncol, 2001, 61(2):165-168. DOI:10.1016/s0167-8140(01)00392-9.
[9] Lu JC, Kong C, Tao H. Radiotherapy with or without concurrent chemotherapy for lymph node recurrence after radical surgery of thoracic esophageal squamous cell carcinoma[J]. Int J Radiat Oncol Biol Phys, 2010, 78(3):710-714. DOI:10.1016/j.ijrobp.2009.08.065.
[10] Butter R, Lagarde SM, van Oijen MGH, et al. Treatment strategies in recurrent esophageal or junctional cancer[J]. Dis Esophagus, 2017, 30(9):1-9. DOI:10.1093/dote/dox082.
[11] Baxi SH, Burmeister B, Harvey JA, et al. Salvage definitive chemo-radiotherapy for locally recurrent oesophageal carcinoma after primary surgery:retrospective review[J]. J Med Imaging Radiat Oncol, 2008, 52(6):583-587. DOI:10.1111/j.1440-1673.2008.02023.x.
[12] Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123(Radiation Therapy Oncology Group 94-05) phase Ⅲ trial of combined-modality therapy for esophageal cancer:high-dose versus standard-dose radiation therapy[J]. J Clin Oncol, 2002, 20(5):1167-1174. DOI:10.1200/JCO.2002.20.5.1167.
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