Three-dimensional conformal radiotherapy with concurrent chemotherapy for postoperative recurrence of esophageal squamous cell carcinoma: clinical efficacy and failure pattern

Abstract

BackgroundTo assess the therapeutic outcome and failure pattern of three-dimensional conformal radiotherapy (3D-CRT)-based concurrent chemoradiotherapy (CCRT) for recurrence of esophageal squamous cell carcinoma (SCC) after radical surgery.MethodsTreatment outcome and failure pattern were retrospectively evaluated in 83 patients with localized cervical and thoracic recurrences after radical surgery for thoracic esophageal SCC. All patients were treated with 3DCRT-based CCRT (median radiation dose 60 Gy), in which 39 received concurrent cisplatin plus 5-fluorouracil (PF), and 44 received concurrent docetaxel plus cisplatin (TP). Treatment response was evaluated at 1–3 months after CCRT.ResultsWith a median follow-up of 34 months (range, 2–116 months), the 3-year overall survival (OS) of all the patients was 51.8% and the median OS time was 43.0 months. The overall tumor response rate was 75.9% (63/83), with a complete remission (CR) rate of 44.6% (37/83). In univariate analysis, tumor response after CCRT (p = 0.000), recurrence site (p = 0.028) and concurrent chemotherapy (p = 0.090) showed a trend favoring better OS. Multivariate analysis revealed that tumor response after CCRT (p = 0.000) and concurrent chemotherapy (p = 0.010) were independent predictors of OS. Forty-seven patients had progressive diseases after CCRT, 27 had local failure (27/47, 57.4%), 18 had distant metastasis (18/47, 38.3%) and 2 had both local and distant failures (2/47, 4.3%).Conclusions3DCRT-based CCRT is effective in postoperatively recurrent esophageal SCC. Patients that obtained complete remission after CCRT appeared to achieve long-term OS and might benefit from concurrent TP regimen. Local and distant failures remained high and prospective studies are needed to validate these factors.

Comparing docetaxel plus cisplatin versus fluorouracil plus cisplatin in esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy

“…Accordingly, multiple studies have investigated the role of docetaxel combined with radiotherapy in either definitive or neoadjuvant CRT settings (15,16,(21)(22)(23)(24)(25)(26)(27). However, no study has directly compared DP with FP in the neoadjuvant CRT setting.…”

Efficacy of PET-CT in the Diagnosis and Treatment of Recurrence After Esophageal Cancer Surgery

“…The effectiveness of multimodal therapies involving chemotherapy, salvage surgery, and salvage CRT against recurrent tumors has already been demonstrated (18,19). Concurrent threedimensional conformal radiotherapy, which is similar to intensity-modulated radiotherapy, and chemotherapy may increase local tumor control, reduce the rate of distant metastasis, and increase long-term survival rates (20,21). These findings suggest that the postoperative recurrence of EC is no longer as incurable as it once was.…”

Concurrent chemoradiotherapy combined with enteral nutrition support: a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant fistulae

“…Two regimens of chemotherapy were used in the study: (1) concurrent chemotherapy consisted of cisplatin (20 mg/m 2 per day) and 5-FU (500 mg/m 2 per day), every 3 weeks; (2) docetaxel-based regimens consisted of docetaxel (60 mg/m 2 per day) and cisplatin (60 mg/m 2 per day), every 3 weeks; or concurrent chemotherapy comprising cisplatin (25 mg/m 2 per day) and docetaxel (25 mg/m 2 per day), weekly [15, 16]. …”

“…Building on our previous work that made the promising effects of CCRT on esophageal carcinoma [15, 16], we treated patients who had advanced esophageal carcinoma and ER or EM fistulae with aggressive CCRT combined with enteral nutrition support. Here, we reviewed and analyzed the clinical results of this treatment strategy for esophageal carcinoma patients who developed malignant fistulae before or during treatment.…”