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Salvage radiotherapy in patients with recurrent esophageal carcinoma

Salvage-Strahlentherapie bei Patienten mit rezidivierendem Ösophaguskarzinom

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Abstract

Purpose

The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported.

Patients and methods

A consecutive cohort of 54 patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy + surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19 months (range 4–79 months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy (range 30–68 Gy).

Results

Median follow-up time for surviving patients from the start of R(C)T was 38 months (range 10–105 months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12 months (95% confidence interval (CI) 7–17 months) and the median recurrence-free interval was 8 months (95% CI 4–12 months). The survival rates at 1, 2, and 3 years were 55 ± 7%, 29 ± 6%, and 19 ± 5%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 44 ± 7%, 22 ± 6%, and 15 ± 5%, respectively. A radiation dose ≥ 45 Gy and conformal RT were associated with a better prognosis.

Conclusion

RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherpy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45 Gy are recommended.

Zusammenfassung

Ziel

Es wird über die Durchführbarkeit und Effektivität der Salvage-Strahlentherapie in der Rezidivsituation bei Patienten mit Ösophaguskarzinom berichtet.

Patienten und Methode

Von 1988–2010 wurden an unserer Klinik 54 Patienten mit einem rezidivierendem rcT1-4-, rcN0-1- oder cM0-Ösophaguskarzinom (69% Plattenepithelkarzinome, 31% Adenokarzinome) mit einer Salvage-Strahlen-(Chemo)-Therapie bis zu einer medianen Dosis von 45 Gy behandelt. Als primäre Therapie hatten 8 (15%) eine definitive Radiochemotherapie, 32 (59%) eine alleinige Operation und 14 (26%) eine neoadjuvante Strahlenchemotherapie mit nachfolgender Operation erhalten. Die mediane Zeit von der primären Therapie bis zum Rezidiv betrug 19 Monate (4–79 Monate). Bei 63% der Patienten war das Rezidiv lokal oder an der Anastomose aufgetreten, bei 30% in den regionären Lymphknoten und bei 7% in beiden Bereichen.

Ergebnisse

Die mediane Follow-up-Dauer für überlebende Patienten ab Beginn der Strahlentherapie betrug 38 Monate (10–105 Monate). Das mediane Gesamtüberleben nach Salvage-Strahlen-(Chemo)-Therapie lag bei 12 Monaten (95%-KI 9–15 Monate), das mediane rezidivfreie Intervall bei 8 Monaten (95%-KI 4–12). Die Gesamtüberlebensraten nach einem Jahr, 2 und 3 Jahren betrugen 55 ± 7%, 29% ± 6% und 19 ± 5%. 44 ± 7%, 22 ± 6% und 15 ± 5% der Patienten waren nach einem Jahr, 2 bzw. 3 Jahren rezidivfrei. Die Symptomatik (Dysphagie) verbesserte sich bei 68% der Patienten. Eine höhere Bestrahlungsdosis als 45 Gy und eine konformale Strahlentherapie waren mit einer besseren Prognose assoziiert.

Schlussfolgerungen

Die Strahlentherapie bei Patienten mit einem rezidivierenden Ösophaguskarzinoms ist machbar und effektiv. Insbesondere im Hinblick auf eine Symptomlinderung. Die Prognose ist dennoch schlecht, wobei ein Langzeitüberleben in einem kleinen Anteil der Patienten zu beobachten ist. Falls eine Re-Bestrahlung für die Behandlung eines Ösophaguskarzinomrezidivs in Betracht gezogen wird, sollte eine 3-D-konformale Technik zur Planung, sowie eine minimale Dosis von 45 Gy angestrebt werden.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    K. Fakhrian, N. Gamisch, T. Schuster, R. Thamm, M. Molls & H. Geinitz

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  1. K. Fakhrian
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  2. N. Gamisch
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  3. T. Schuster
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  4. R. Thamm
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  5. M. Molls
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  6. H. Geinitz
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Correspondence to K. Fakhrian.

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Fakhrian, K., Gamisch, N., Schuster, T. et al. Salvage radiotherapy in patients with recurrent esophageal carcinoma. Strahlenther Onkol 188, 136–142 (2012). https://doi.org/10.1007/s00066-011-0023-x

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