Patterns of recurrence after trimodality therapy for esophageal cancer.
BACKGROUND
Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined.


METHODS
All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery.


RESULTS
Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥ 2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%).


CONCLUSIONS
Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes.
Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Jennifer A
JA
Dorth
John A
JA
Pura
Manisha
M
Palta
Christopher G
CG
Willett
Hope E
HE
Uronis
Thomas A
TA
D'Amico
Brian G
BG
Czito
D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D017671:Platinum Compounds / Q000008:administration & dosage; D049268:Positron-Emission Tomography; D011879:Radiotherapy Dosage; D043823:Taxoids / Q000008:administration & dosage; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents; D017671:Platinum Compounds; D043823:Taxoids; D005472:Fluorouracil
esophageal cancer; esophagectomy; lymphatic irradiation; lymphatic metastasis