Endoscopic classification of local recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma

Abstract

Background. It is unknown whether the endoscopic appearance of local recurrent squamous cell esophageal cancer treated with defi nitive chemoradiotherapy is predictive of the subsequent clinical course. Methods. We conducted a retrospective review of 19 patients with local recurrence. Local recurrence was classifi ed into three types as seen by endoscopy. Of 19 local recurrences, 9 lesions were classifi ed into superfi cial type, 7 lesions into submucosal tumor type, and 3 lesions into ulcerative type. The association between the endoscopic appearance of T1 local recurrence (rT1) and its clinical course was then evaluated. Results. Of 19 local recurrences, 13 were diagnosed as rT1 cancer. Three of nine patients with superfi cial-type recurrence were treated by surgical resection; the other six patients received endoscopic treatment. One of nine patients with a superfi cial-type recurrence died of abdominal lymph node recurrence. The other eight patients are alive without further recurrence. All four patients with rT1 submucosal tumor type recurrence received endoscopic treatment. After the diagnosis of local recurrence, lung or abdominal lymph node metastasis developed in three patients and two patients died of their disease. The median survival time for the submucosal tumor type was 26 months; median survival of the superfi cial type was not reached (P = 0.09).Conclusions. Superfi cial-type rT1 recurrence had a good prognosis with a low rate of nonlocal recurrence, whereas submucosal tumor type rT1 recurrence had a relatively high nonlocal recurrence rate and mortality.