Survival benefit of multimodal local therapy for repeat recurrence of thoracic esophageal squamous cell carcinoma after esophagectomy.
Esophageal neoplasm
Intensity-modulated radiotherapy
Recurrence
Surgery
Journal
Esophagus : official journal of the Japan Esophageal Society
ISSN: 1612-9067
Titre abrégé: Esophagus
Pays: Japan
ID NLM: 101206627
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
28
05
2018
accepted:
21
08
2018
pubmed:
30
8
2018
medline:
29
5
2019
entrez:
30
8
2018
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
This study was performed to clarify the optimal therapeutic strategy for recurrent disease after esophagectomy.
METHODS
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.
RESULTS
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.
CONCLUSIONS
Multimodal local therapy for repeat recurrence after TE contributes to the improvement of survival after recurrence.
Identifiants
pubmed: 30155745
doi: 10.1007/s10388-018-0638-4
pii: 10.1007/s10388-018-0638-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
107-113Références
Bhansali MS, Fujita H, Kakegawa T, et al. Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus. World J Surg. 1997;21:275–81.
doi: 10.1007/s002689900228
pubmed: 9015170
Mariette C, Balon JM, Piessen G, et al. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer. 2003;97:1616–23.
doi: 10.1002/cncr.11228
pubmed: 12655517
Nakagawa S, Kanda T, Kosugi S, et al. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198:205–11.
doi: 10.1016/j.jamcollsurg.2003.10.005
pubmed: 14759776
Miyata H, Yamasaki M, Kurokawa Y, et al. Survival factors in patients with recurrence after curative resection of esophageal squamous cell carcinomas. Ann Surg Oncol. 2011;18:3353–61.
doi: 10.1245/s10434-011-1747-7
pubmed: 21537861
Ninomiya I, Osugi H, Fujimura T, et al. Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period. Gen Thorac Cardiovasc Surg. 2008;56:119–25.
doi: 10.1007/s11748-007-0196-5
pubmed: 18340511
Ninomiya I, Okamoto K, Fujimura T, et al. Oncologic outcomes of thoracoscopic esophagectomy with extended lymph node dissection: 10-year experience from a single center. World J Surg. 2014;38:120–30.
doi: 10.1007/s00268-013-2238-8
pubmed: 24101019
Ninomiya I, Okamoto K, Tsukada T, et al. Recurrence patterns and risk factors following thoracoscopic esophagectomy with radical lymph node dissection for thoracic esophageal squamous cell carcinoma. Mol Clin Oncol. 2016;4:278–84.
doi: 10.3892/mco.2015.688
pubmed: 26893875
Thomson IG, Smithers BM, Gotley DC, et al. Thoracoscopic-assisted esophagectomy for esophageal cancer: analysis of patterns and prognostic factors for recurrence. Ann Surg. 2010;252:281–91.
doi: 10.1097/SLA.0b013e3181e909a2
pubmed: 20647926
Yano M, Takachi K, Doki Y, et al. Prognosis of patients who develop cervical lymph node recurrence following curative resection for thoracic esophageal cancer. Dis Esophagus. 2006;19:73–7.
doi: 10.1111/j.1442-2050.2006.00543.x
pubmed: 16643173
Watanabe M, Nishida K, Kimura Y, et al. Salvage lymphadenectomy for cervical lymph node recurrence after esophagectomy for squamous cell carcinoma of the thoracic esophagus. Dis Esophagus. 2012;25:62–6.
doi: 10.1111/j.1442-2050.2011.01215.x
pubmed: 21676066
Nakamura T, Ota M, Narumiya K, et al. Multimodal treatment for lymph node recurrence of esophageal carcinoma after curative resection. Ann Surg Oncol. 2008;15:2451–7.
doi: 10.1245/s10434-008-0016-x
pubmed: 18592318
Watanabe M, Mine S, Yamada K, et al. Outcomes of lymphadenectomy for lymph node recurrence after esophagectomy or definitive chemoradiotherapy for squamous cell carcinoma of the esophagus. Gen Thorac Cardiovasc Surg. 2014;62:685–92.
doi: 10.1007/s11748-014-0444-4
pubmed: 24965711
Takemura M, Sakurai K, Takii M, et al. Metachronous pulmonary metastasis after radical esophagectomy for esophageal cancer: prognosis and outcome. J Cardiothorac Surg. 2012;7:103.
doi: 10.1186/1749-8090-7-103
pubmed: 23031450
pmcid: 3504510
Taguchi S, Osugi H, Higashino M, et al. Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc. 2003;17:1445–50 Epub 2003 Jun 19.
doi: 10.1007/s00464-002-9232-9
pubmed: 12811660
Kobayashi R, Yamashita H, Okuma K, et al. Salvage radiation therapy and chemoradiation therapy for postoperative locoregional recurrence of esophageal cancer. Dis Esophagus. 2014;27:72–8.
doi: 10.1111/dote.12068
pubmed: 23551708
Nutting CM, Bedford JL, Cosgrove VP, et al. A comparison of conformal and intensity-modulated techniques for oesophageal radiotherapy. Radiother Oncol. 2001;61:157–63.
doi: 10.1016/S0167-8140(01)00438-8
pubmed: 11690681
Chandra A, Guerrero TM, Liu HH, et al. Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer. Radiother Oncol. 2005;77:247–53.
doi: 10.1016/j.radonc.2005.10.017
pubmed: 16298001
Kole TP, Aghayere O, Kwah J, et al. Comparison of heart and coronary artery doses associated with intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for distal esophageal cancer. Int J Radiat Oncol Biol Phys. 2012;83:1580–6.
doi: 10.1016/j.ijrobp.2011.10.053
pubmed: 22284687
Du XL, Sheng XG, Jiang T, et al. Intensity-modulated radiation therapy versus para-aortic field radiotherapy to treat para-aortic lymph node metastasis in cervical cancer: prospective study. Croat Med J. 2010;51:229–36.
doi: 10.3325/cmj.2010.51.229
pubmed: 20564766
pmcid: 2897095