title: Definitive salvage radiation therapy and chemoradiation therapy for lymph node oligo-recurrence of esophageal cancer: a Japanese multi-institutional study of 237 patients.
abstract: BACKGROUND
  This study evaluated the treatment results of lymph node (LN) oligo-recurrence in esophageal cancer patients treated with salvage radiotherapy (RT) in a multi-institutional retrospective study.
  
  
  METHODS
  Eligibility criteria for this retrospective analysis were: the primary lesion of esophageal cancer was controlled; from one to five LN recurrences; total RT dose ≥45 Gy to exclude palliative RT; without recurrence other than LN; and salvage RT for LN recurrence was given between January 2000 and April 2015. The median follow-up time for the 93 living patients was 29.6 months.
  
  
  RESULTS
  Two hundred thirty-seven patients were matched in five hospitals. The 3-year overall survival (OS) was 37%, local control was 45%, progression-free survival was 24%, and esophageal cancer-specific survival was 42%. On univariate analysis for OS, combined chemotherapy (p = 0.000055), disease-free interval (DFI) ≥12 months (p = 0.0013), LN max diameter ≤22 mm (p = 0.0052), and Karnofsky performance status ≥80% (p = 0.030) were associated with a significantly better prognosis. On multivariate analysis, significant differences were seen for combined chemotherapy (p = 0.000018), DFI (p = 0.0027), and LN max diameter (p = 0.018).
  
  
  CONCLUSIONS
  LN oligo-recurrence following treatment for esophageal cancer was not a terminal-stage event. Moreover, cure may be possible by chemoradiation therapy with a long DFI (≥12 months) and small size (≤22 mm).
authors.affiliation: Department of Radiology, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Hideomi
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-cho, Aoba-ku, Sendai, 980-8575, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Jingu
authors.affiliation: Department of Radiology, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan. yuzuru.niibe@med.toho-u.ac.jp.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Niibe
authors.affiliation: Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Katsui
authors.affiliation: Department of Gastrointestinal Medicine, Shikoku Cancer Center, Kou 160, Umemoto-cho, Matsuyama, Ehime, 791-0280, Japan.|Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Gastrointestinal Medicine, Shikoku Cancer Center, Kou 160, Umemoto-cho, Matsuyama, Ehime, 791-0280, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nishina
authors.affiliation: Department of Radiology, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
authors.forename: Atsuro
authors.initials: A
authors.lastname: Terahara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
keywords: Esophageal cancer; Oligo-recurrence; Oligometastases; Salvage chemoradiation therapy; Salvage radiation therapy