Definitive salvage radiation therapy and chemoradiation therapy for lymph node oligo-recurrence of esophageal cancer: a
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RESEARCH
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Definitive salvage radiation therapy and chemoradiation therapy for lymph node oligo-recurrence of esophageal cancer: a Japanese multi-institutional study of 237 patients Hideomi Yamashita1, Keiichi Jingu2, Yuzuru Niibe3*, Kuniaki Katsui4, Toshihiko Matsumoto5,6, Tomohiro Nishina5 and Atsuro Terahara3
Abstract Background: This study evaluated the treatment results of lymph node (LN) oligo-recurrence in esophageal cancer patients treated with salvage radiotherapy (RT) in a multi-institutional retrospective study. Methods: Eligibility criteria for this retrospective analysis were: the primary lesion of esophageal cancer was controlled; from one to five LN recurrences; total RT dose ≥45 Gy to exclude palliative RT; without recurrence other than LN; and salvage RT for LN recurrence was given between January 2000 and April 2015. The median follow-up time for the 93 living patients was 29.6 months. Results: Two hundred thirty-seven patients were matched in five hospitals. The 3-year overall survival (OS) was 37%, local control was 45%, progression-free survival was 24%, and esophageal cancer-specific survival was 42%. On univariate analysis for OS, combined chemotherapy (p = 0.000055), disease-free interval (DFI) ≥12 months (p = 0. 0013), LN max diameter ≤22 mm (p = 0.0052), and Karnofsky performance status ≥80% (p = 0.030) were associated with a significantly better prognosis. On multivariate analysis, significant differences were seen for combined chemotherapy (p = 0.000018), DFI (p = 0.0027), and LN max diameter (p = 0.018). Conclusions: LN oligo-recurrence following treatment for esophageal cancer was not a terminal-stage event. Moreover, cure may be possible by chemoradiation therapy with a long DFI (≥12 months) and small size (≤22 mm). Keywords: Esophageal cancer, Oligo-recurrence, Oligometastases, Salvage chemoradiation therapy, Salvage radiation therapy
Background Lymph node (LN) recurrence from esophageal cancer after surgery is one of the main types of treatment failure [1–3]. According to several reports, 42.5–52.4% of operated patients develop recurrence, and these patients’ prognosis remains poor [4–8]. The median survival time * Correspondence: [email protected] This study was partly presented at the 58th Annual Meeting of American Society for Radiation Oncology (ASTRO), September 25-28, 2016, Boston, USA. 3 Department of Radiology, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan Full list of author information is available at the end of the article
(MST) of all postoperative recurrent esophageal cancers including loco-regional, distant, and combined recurrence has been shown to be 6.0–8.2 months [1, 5]. Although some analyses indicated that treatment of locoregional recurrence (LR) prolonged survival regardless of the treatment type, the outcome of patients treated with chemotherapy (CTx) alone was significantly worse than for patients treated with other intensive therapies [9]. Therefore, CTx alone is usually reserved for patie
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