Outcomes of Radiation-Associated Esophageal Squamous Cell Carcinoma: The MSKCC Experience
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Esophageal squamous cell carcinoma (ESCC-R) is a rarely encountered sequela of chest radiation. Treatment is limited by toxicity with reirradiation and complex surgical dissection in a previously radiated field. The clinical presentation, prognosis, and treatment selection of ESCC-R remain undefined.
A retrospective review of patients with esophageal squamous cell carcinoma at a single institution between 2000 and 2017 was performed to identify patients with previous radiation therapy (≥ 5 years delay). Clinicopathologic characteristics, treatment, and outcomes of ESCC-R (n = 69) patients were compared to patients with primary esophageal squamous cell carcinoma (ESCC) (n = 827). Overall survival (OS) and cumulative incidence of recurrence (CIR) were compared using log-rank and Gray’s tests, respectively.
Median time from radiation to ESCC-R was 18.2 years. The majority of ESCC-R patients were female and presented with earlier disease and decreased behavioral risk factors. ESCC-R treated with surgery alone had worse OS than ESCC (5-year 15 vs 33%; p = 0.045). Patients with ESCC-R who received neoadjuvant treatment had higher risk of postoperative in-house mortality (16.7 vs 4.2%; p = 0.032). Patients with ESCC-R treated with surgery alone and definitive chemoradiation had higher recurrence risk than those with neoadjuvant + surgery (5-year recurrence 55 and 45 vs 15%; p = 0.101).
Neoadjuvant chemotherapy or chemoradiation should be used whenever possible for ESCC-R as it is associated with lower risk of recurrence. The improved survival benefits of aggressive treatment must be weighed against the higher associated postoperative risks.
KeywordsEsophageal squamous cell carcinoma Reirradiation Treatment selection Neoadjuvant therapy
The authors would like to thank Furio Nick Savone, lymphoma and esophageal cancer survivor, for inspiring the design and development of this study.
This study was supported, in part, by the National Institutes of Health/National Cancer Institute Cancer Support Grant P30 CA008748. Tamar Nobel is supported, in part, by a grant from the American Cancer Society.
Tamar Nobel, Arianna Barbetta, David Jones, and Daniela Molena contributed to the conception and design of the work. Tamar Nobel, Arianna Barbetta, Tiffany Pinchinat, Franscisco Schlottman, Manjit Bains, Geoffrey Ku, Abraham Wu, and Marco G. Patti contributed to the acquisition and interpretation of data. Meier Hsu and Kay See Tan contributed to the analysis and interpretation of data. Tamar Nobel, Meier Hsu, Kay See Tan, and Daniela Molena wrote the manuscript with critical revision from all other authors. All authors are in agreement to be accountable for ensuring the accuracy and integrity of the work.
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