Increased dose of re-irradiation therapy or combined chemotherapy to improve survival of local recurrent esophageal squamous cell carcinoma after radiotherapy

Abstract

Introduction: This study aimed to explore the optimal treatment for locally recurrent esophageal squamous cell carcinoma (LRESCC) by analyzing the results of different doses of re-irradiation therapy after radical (chemo) radiotherapy. Methods: We retrospectively analyzed 125 patients with LRESCC after initial radiotherapy. According to radiotherapy dose, 58 patients were assigned to the low-dose (LD) group (50–54 Gy) and 67 to the high-dose (HD) group (55–60 Gy). We recorded the response rate (complete + partial response), 1-, 2- and 3-year survival rates, and toxicity in the two groups. The effects of different radiotherapy doses and combination chemotherapy on the survival of LRESCC were analyzed. Results: After re-irradiation, the 1-, 2- and 3-year survival rates were 48.3%, 24.1% and 10.3% in the LD group and 61.2%, 34.3% and 19.4% in the HD group (P<0.05), respectively. The median survival time of patients receiving radiotherapy alone was 9 months in the LD group and 15 months in the HD group (P<0.05). The survival rate of patients treated with chemoradiotherapy was higher than that of patients treated with radiotherapy alone in the LD group, but in the HD group, chemoradiotherapy showed no advantage compared with radiotherapy alone. The most common toxicity was esophagitis, and the incidence was higher in the HD group than in the LD group (68.7% vs 58.6%, P＜0.05). Conclusion: Increasing the dose of re-irradiation therapy or chemotherapy can improve the efficacy of re-irradiation therapy for patients with LRESCC after radiotherapy.