title: Definitive chemoradiation for locoregional recurrences of esophageal cancer after primary curative treatment.
abstract: The aim of this study was to determine the outcome of salvage definitive chemoradiation (dCRT) for a locoregional recurrence after any prior curative treatment outside previously irradiated areas. Thirty-nine patients treated between January 2005 and December 2014 were reviewed for locoregional recurrent esophageal cancer outside previously irradiated areas. All patients received salvage treatment with external beam radiotherapy (50.4 Gy in 28 fractions) combined with weekly concurrent paclitaxel and carboplatin. The median follow-up period was 15 months (range 1.7-120). The median overall survival (OS) for all patients after salvage dCRT was 22 months (95% CI 6.2-37.6). The 1-, 3-, and 5-year OS was 72%, 31%, and 28%, respectively. Median survival after salvage dCRT for a regional lymph node recurrence was 33 months (95% CI 5.8-60.3) versus 14 months (95% CI 6.8-21.6) for a recurrence at the anastomosis (P = 0.022, logrank). Median OS was 35 months for the squamous cell carcinoma group and 19 months for the adenocarcinoma group (P = 0.67). Sixteen of 39 patients developed a locoregional recurrence after salvaged dCRT. The median locoregional recurrence-free survival (LRFS) was 24 months. The 1-, 3-, and 5-year LRFS was 79%, 36%, and 36%, respectively. Median disease-free survival (DFS) was 15 months. The 1-, 3-, and 5-year DFS was 66%, 27%, and 27%, respectively. Of 16 patients, 8 (50%) with a primary failure at the site of the anastomosis developed a local recurrence after salvaged dCRT compared to 7 of 22 patients (32%) with a primary recurrence in a lymph node. Definitive chemoradiation is a feasible and effective treatment for locoregional recurrent esophageal cancer outside a previously irradiated area, and should be given with a curative intent. This holds true for recurrence of both squamous cell carcinoma and adenocarcinoma. Lymph node recurrences have a markedly better prognosis than recurrences at the site of the anastomosis.
authors.affiliation: Departments of Radiotherapy,  Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Jeene
authors.affiliation: Departments of Radiotherapy,  Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Versteijne
authors.affiliation: Departments of Surgery,  , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Departments of Gastroenterology,  , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: J J G H M
authors.initials: JJ
authors.lastname: Bergmann
authors.affiliation: Departments of Radiotherapy,  Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: E D
authors.initials: ED
authors.lastname: Geijsen
authors.affiliation: Department of Radiotherapy, Radiotherapiegroep, Deventer, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Muller
authors.affiliation: Departments of Medical Oncology, Academic Medical center Amsterdam, Amsterdam.
authors.forename: H W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.affiliation: Departments of Radiotherapy,  Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: M C C M
authors.initials: MC
authors.lastname: Hulshof
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016190:Carboplatin; D017239:Paclitaxel
keywords: definitive chemoradiation; esophageal cancer; locoregional recurrence; salvage radiotherapy