Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,BeiJing 100021,China (Ni WJ,Yang JS:Department of Radiotherapy Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Yu SF:Department of Radiotherapy of Beijing Chaoyang Hospital Affiliated to Capital Medical University,Zhang WC:Department of Radiotherapy of Tianjin Cancer Hospital)
Abstract Objective To evaluate the efficacy of rescue treatment for recurrent esophageal cancer after radical esophagectomy, and to provide insights into the development of comprehensive treatment for esophageal cancer. Methods The clinical data of 218 patients who were confirmed with recurrent metastatic esophageal cancer after R0 resection and received rescue treatment in our hospital from 2004 to 2014 were retrospectively reviewed. The survival rate was determined by the Kaplan-Meier method. Univariate and multivariate prognostic analyses were performed using the log-rank test and Cox proportional hazards model, respectively. Results The median post-recurrence follow-up time was 53 months. The 1-and 3-year overall survival (OS) rates after recurrence were 57.2% and 24.4%, respectively. Among the 163 patients with local recurrence, the 1-and 3-year OS rates were 70% and 42% for patients treated with chemoradiotherapy (n=40), 55% and 24% for those with radiotherapy alone (n=106), and 23% and 8% for those with supportive therapy (n=13)(chemoradiotherapy vs. radiotherapy alone P=0.045, radiotherapy alone vs. supportive therapy P=0.004;none of the patients who were treated with chemotherapy alone survived for one year or more). Univariate analysis showed that N staging, TNM staging, and post-recurrence rescue treatment regimen were independent prognostic factors for esophageal cancer (all P=0.001). On the other hand, multivariate analysis indicated that only rescue treatment regimen was the independent prognostic factor for esophageal cancer (P=0.013). Conclusions Rescue chemoradiotherapy or radiotherapy alone can bring significant survival benefits for patients with recurrent and metastatic, especially locally recurrent, esophageal cancer following radical esophagectomy.
Ni Wenjie,Yang Jin-song,Yu Shufei et al. Efficacy evaluation of rescue treatment for 218 patients with recurrent esophageal cancer after radical resection [J]. Chinese Journal of Radiation Oncology, 2017, 26(7): 744-748.
Ni Wenjie,Yang Jin-song,Yu Shufei et al. Efficacy evaluation of rescue treatment for 218 patients with recurrent esophageal cancer after radical resection [J]. Chinese Journal of Radiation Oncology, 2017, 26(7): 744-748.
[1] Hsu PK,Wang BY,Huang CS,et al. Prognostic factors for post-recurrence survival in esophageal squamous cell carcinoma patients with recurrence after resection[J].J Gastrointest Surg,2011,15(4):558-565.DOI:10.1007/ s11605-011-1458-1. [2] Miyata H,Yamasaki M,Kurokawa Y,et al. Survival factors in patients with recurrence after curative resection of esophageal squamous cell carcinomas[J].Ann Surg Oncol,2011,18(12):3353-3361.DOI:10.1245/s10434-011-1747-7. [3] Lu JC,Tao H,Song D,et al. Recurrence risk model for esophageal cancer after radical surgery[J].Chin J Cancer Res,2013,25(5):549-555.DOI:10.3978/j.issn.1000-9604.2013.10.05. [4] Oppedijk V,van der Gaast A,van Lanschot JJB,et al. Patterns of recurrence after srurgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials[J].J Clin Oncol,2014,32(5):385-391.DOI:10.1200/JCO.2013.51.2186. [5] Liu Q,Cai XW,Wu B,et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma:implications for the clinical target volume design of postoperative radiotherapy[J].PLoS One,2014,9(5):e97225.DOI:10.1371/journal.pone.0097225. [6] Guo XF,Mao T,Gu ZT,et al. Clinical study on postoperative recurrence in patients with pN0 esophageal squamous cell carcinoma[J].J Cardiothorac Surg,2014,9(1):150.DOI:10.1186/s13019-014-0150-4. [7] Su XD,Zhang DK,Zhang X,et al. Prognostic factors in patients with recurrence after complete resection of esophageal squamous cell carcinoma[J].J Thorac Dis,2014,6(7):949-957.DOI:10.3978/j.issn.2072-1439.2014.07.14. [9] Raoul JL,Le Prisé E,Meunier B,et al. Combined radiochemotherapy for postoperative recurrence of oesophageal cancer[J].Gut,1995,37(2):174-176.DOI:10.1136/gut.37.2.174. [9] 桑玫,陈建华,刘海龙.食管癌术后复发的治疗结果[J].中国癌症杂志,2000,10(5):413-415.DOI:10.3969/j.issn.1007-3639.2000.05.013. Sang M,Chen JH,Liu HL.Analysis on the treatment results for recurrent postoperative esophagus[J].China Oncol,2000,10(5):413-415.DOI:10.3969/j.issn.1007-3639.2000.05 013. [10] 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. [11] 李博,章文成,赵路军,等.食管癌根治术后复发的治疗策略[J].中国肿瘤临床,2013,40(24):1553-1557.DOI:10.3969/j.issn.1000-8179.20131379. Li B,Zhang WC,Zhao LJ,et al. Therapeutic strategy to prevent the recurrence of esophageal carcinoma after radical resection[J].Chin J Clin Oncol,2013,40(24):1553-1557.DOI:10.3969/j.issn.1000-8179.20131379. [12] 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. [13] 许亚萍,毛伟敏,马胜林,等.食管癌根治性治疗后局部复发患者的预后因素分析[J].中华肿瘤杂志,2011,33(12):925-928.DOI:10.3760/cma.j.issn.0253-3766.2011.12.010. Xu YP,Mao WM,Ma SL,et al. Analysis of prognostic factors in patients with locoregional recurrence of esophageal carcinoma after curative treatment[J].Chin J Oncol,2011,33(12):925-928.DOI:10.3760/cma.j.issn.0253-3766.2011.12.010.