title: Elective nodal irradiation is not necessary in chemoradiotherapy for postoperative loco-regional recurrent esophageal cancer.
abstract: OBJECTIVE
  The purposes of the present study were to evaluate prognostic factors for patients with postoperative loco-regional recurrent esophageal cancer treated with chemoradiotherapy by multivariate analysis and to determine which irradiation is better, involved field irradiation or elective nodal irradiation, by matched-pair analysis.
  
  
  METHODS
  We reviewed records for 80 patients with postoperative loco-regional recurrent esophageal cancer treated by chemoradiotherapy between 2000 and 2014. The median follow-up period was 62.0 months. Thirty-one cases were treated with elective nodal irradiation and were randomly matched by risk factors to 49 cases treated with involved field irradiation (1:1).
  
  
  RESULTS
  Fifty-one patients had disease recurrence again, and irradiated-field failure was observed in 26 patients. The 5-year overall survival rate was 30.5% with a median survival period of 26.5 months. Grade 3 or higher late toxicity was observed in only one patient. In multivariate analysis, short disease-free interval and anastomotic recurrence were statistically significant unfavorable prognostic factors for overall survival (hazard ratios: 2.1 and 2.5, respectively). Matched-pair analysis including disease-free interval, pattern of recurrence and number of recurrent regions revealed that overall survival rate and irradiated-field control rate in patients treated with involved field irradiation were significantly better than those in patients treated with elective nodal irradiation (P = 0.016 and P = 0.014, respectively).
  
  
  CONCLUSIONS
  Short disease-free interval and anastomotic recurrence are unfavorable factors and elective nodal irradiation is not necessary in chemoradiotherapy for patients with postoperative loco-regional recurrent esophageal cancer.
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Jingu
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Umezawa
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Takaya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Matsushita
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Youjirou
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Kozumi
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kubozono
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kadoya
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Takeda
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011184:Postoperative Period; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate
keywords: chemoradiotherapy; involved field irradiation; postoperative loco-regional recurrent esophageal cancer; prognostic factor