Efficacy and toxicity of re-irradiation for esophageal cancer patients with locoregional recurrence: a retrospective ana
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RESEARCH
Efficacy and toxicity of re‑irradiation for esophageal cancer patients with locoregional recurrence: a retrospective analysis Kaikai Zhao1, Youjiao Si2, Liangchao Sun3, Xiangjiao Meng3* and Jinming Yu3*
Abstract Introduction: There is no standard treatment for locoregional recurrent (LR) esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) previously. This retrospective study aimed to examine the efficacy and toxicity of re-irradiation (re-RT) for ESCC patients with LR. Patients and methods: A total of 252 patients were enrolled. Gross tumor volumes for re-RT were defined using contrast enhanced computed tomography and/or positron emission tomography/computed tomography. Overall survival (OS), after recurrence survival (ARS) and toxicities were assessed. Results: Through a median follow-up of 38 months, the median OS and ARS were 39.0 and 13.0 months, respectively. The 6-, 12-, and 24-month ARS rates were 81.9%, 50.5%, and 21.8%, respectively. Multivariate analyses showed that chemotherapy, esophageal stenosis and recurrence-free interval (RFI) may be independent prognostic factors for ARS. The incidence of esophageal fistula/perforation (EP), radiation-induced pneumonitis and esophagorrhagia was 21.4%, 12.8% and 9.1%, respectively. RFI ≤ 12 months, esophageal stenosis and fat space between tumor and adjacent tissue disappeared were independent risk factors for the development of EP after re-RT. Conclusions: Re-RT was feasible for LR ESCC patients after RT initially, the complication occurred in re-RT is acceptable. Patients with RFI ≤ 12 months, esophageal stenosis and fat space between tumor and adjacent tissue disappeared should be closely observed during and after re-RT. Keywords: Esophageal squamous cell carcinoma, Locoregional recurrence, Re-irradiation, Prognosis Introduction Esophageal cancer is the 6th most common cause of cancer deaths worldwide because of its high malignant potential and poor prognosis [1]. Locoregional recurrence (LR) is the major type of failure form in 24–50% of the patients after initial therapy such as surgery and/or *Correspondence: [email protected]; [email protected] 3 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China Full list of author information is available at the end of the article
chemoradiotherapy (CRT) [2, 3], and in-field relapse after radiotherapy (RT) occurred in more than 20% of patients [4, 5]. The 5-year survival rate drops dramatically down to 0–11% once recurrence occurs [6, 7]. Patients with good physical conditions need to be given active treatment to local recurrent disease to achieve better survival. There is no standard treatment for patients with LR so far. Surgery plays an important role in achieving locoregional control in patients with LR esophageal carcinoma [8] but salvage esophagectomy may cause serious surgery-related complication and hospital mortality. CRT has curati
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