title: Surgically treated oesophageal cancer developed in a radiated field: Impact on peri-operative and long-term outcomes.
abstract: The objectives of this study were to compare peri-operative and long-term outcomes from oesophageal cancer (EC) (i) that arose in a previously radiated field (ECRF) versus primary (PEC) and among ECRF patients and (ii) radiotherapy-induced (RIEC) versus non-radiotherapy-induced EC (NRIEC).
  
  
  
  Data were collected from 30 European centres from 2000 to 2010. Two thousand four hundred eighty nine EC patients surgically treated were included in the PEC group and 136 in the ECRF group, NRIEC group (n = 61) and RIEC group (n = 75). Propensity score matching analyses were used to compensate for differences in baseline characteristics.
  
  
  
  Compared to the PEC group, the ECRF group was characterised by less use of neoadjuvant chemoradiotherapy (0% versus 29.5%; P < 0.001), less pathological stage III/IV (31.6% versus 39.2%, P = 0.036), greater incidence of R1/2 margins (21.3% versus 10.9%; P < 0.001), increased in-hospital mortality (14.0% versus 7.1%; P = 0.003) and overall morbidity (68.4% versus 56.4%, P = 0.006). After matching, 5-year overall (28.8% versus 50.5%; hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15-2.04; P = 0.003) and event-free (32.2% versus 42.5%; HR = 1.56, 95% CI: 1.18-2.05; P = 0.002) survivals were significantly reduced in the ECRF group. There were no significant differences in incidence or pattern of tumour recurrence. Comparing RIEC and NRIEC groups, there were no significant differences in short- or long-term outcomes before and after matching.
  
  
  
  ECRF is associated with poorer long-term survival related to a reduced utilisation of neoadjuvant chemoradiotherapy and an increased incidence of tumour margin involvement at surgery. Outcomes appear to be dictated by the limitations related to previous radiotherapy administration more than the radiotherapy-induced carcinogenesis.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.affiliation: Univ. Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France; Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000 Lille, France; Inserm, UMR-S 1172, F-59000 Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.affiliation: Department of Digestive Surgery of Edouard Herriot University Hospital, Lyon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pasquer
authors.affiliation: SIRIC OncoLille, France; Univ. Lille, Department of Biostatistics, University Hospital, F-59000 Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: SIRIC OncoLille, France; Univ. Lille, Department of Biostatistics, University Hospital, F-59000 Lille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Behal
authors.affiliation: Cavale Blanche University Hospital, Brest, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Théreaux
authors.affiliation: Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Gagnière
authors.affiliation: Côte de Nacre University Hospital, Caen, France.
authors.forename: Gil
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Hautepierre University Hospital, Strasbourg, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Brigand
authors.affiliation: Pontchaillou University Hospital, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.affiliation: Univ. Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France; Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000 Lille, France; Inserm, UMR-S 1172, F-59000 Lille, France; SIRIC OncoLille, France. Electronic address: christophe.mariette@chru-lille.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011878:Radiotherapy / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Breast cancer; Oesophageal cancer; Radiotherapy-induced neoplasm; Second primary malignancy; Survival