title: Definitive therapy for isolated esophageal metastases prolongs survival.
abstract: BACKGROUND
  Local and distant recurrences are frequent after curative resection for esophageal cancer and are considered uniformly fatal. However, some patients may present with isolated recurrences that appear amenable to definitive local therapy either by resection or chemoradiotherapy. We reviewed the clinical outcome of all patients with isolated nodal or distant metastases who were treated with curative intent.
  
  
  METHODS
  In this retrospective review, all patients (n=561) who underwent curative resection for esophageal cancer from 1988 to 2011 were identified from a prospectively assembled thoracic surgery database. Patients who had any type of recurrence were identified (n=205). In this group, 27 patients were identified with isolated disease defined as single station of nodal disease or isolated distant metastases. Survival was modeled using the Kaplan-Meier method, and subgroup survival estimates were compared by the log rank test. The impact of age, sex, histology, pathology stage, site of recurrence, and treatment modality on mortality were analyzed by logistic regression.
  
  
  RESULTS
  Twenty-seven patients (22 male, median age 61 years) had an isolated esophageal cancer recurrence; of those, 15 patients underwent surgical resection and 12 underwent definitive chemoradiation therapy. The sites of isolated recurrence were most commonly nodal. Median overall survival from time of recurrence was 25.2 months; 3-year estimated survival was 33.0% (confidence interval: 13.7 to 52.5). In univariate analysis, no relationship was formed.
  
  
  CONCLUSIONS
  In appropriately selected patients with isolated esophageal metastases, definitive therapy can prolong survival. A long disease-free interval and recurrence limited to single nodal stations may select patients likely to have longer survival after definitive local therapy.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Weston
authors.initials: W
authors.lastname: Andrews
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate