Survival benefit of multimodal local therapy for repeat recurrence of thoracic esophageal squamous cell carcinoma after esophagectomy
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This study was performed to clarify the optimal therapeutic strategy for recurrent disease after esophagectomy.
We investigated the prognosis of 37 patients who developed recurrence among 128 patients who underwent curative thoracoscopic esophagectomy (TE) at Kanazawa University Hospital. The prognostic factors after recurrence were examined by univariate and multivariate analyses.
Of these 37 recurrences, 29 patients underwent local therapy (surgery, 10 patients; surgery followed by radiation, 2 patients; radiation, 17 patients). Radiation includes intensity-modulated radiation therapy, chemoradiation, and simple radiation therapy. Seventeen patients (58.6%) were considered to have undergone successful therapy by disappearance or diminishment of the targeted region without regrowth. Eleven of 17 patients (64.7%) showed repeat recurrence at another site. Multiple local therapy was performed for repeat recurrence or uncontrollable first therapy. Finally, 57 local therapies were performed. Using multimodal local therapy, 37 (64.9%) of 57 recurrences were successfully managed. The 12 patients treated by surgery as the initial therapy showed the most favorable survival. Seventeen patients who underwent successful initial therapy showed better survival than others. Multiple or miscellaneous organ metastasis, abdominal lymphatic recurrence and best supportive care at recurrence were statistically significant negative variables for survival after recurrence. Performance of surgery and successful therapy as the initial recurrence were statistically significant positive variables for survival after recurrence. Multivariate analysis showed that successful therapy at the initial recurrence was the only independent variable for survival after recurrence.
Multimodal local therapy for repeat recurrence after TE contributes to the improvement of survival after recurrence.
KeywordsEsophageal neoplasm Recurrence Surgery Intensity-modulated radiotherapy
The authors thank Dr. Isao Matsumoto from the Department of Thoracic, Cardiovascular and General Surgery for resection of the lung metastasis and Dr. Tsuyoshi Takanaka from the Department of Radiation Oncology for performance of the radiation therapy.
Compliance with ethical standards
All patients provided written informed consent before the treatment, and the study was approved by the Ethics Committee of Kanazawa University Hospital. This work conforms to the guidelines set forth in the Helsinki Declaration of 1975 and later versions.
Conflict of interest
All authors declare that they have no conflict of interest.