Concurrent chemoradiotherapy using low-dose continuous infusion of 5-fluorouracil for postoperative regional lymph node recurrence of esophageal squamous cell carcinoma

Abstract

Radiotherapy plays an important role in salvaging patients who suffer locoregional recurrence; however, it displays poor prognosis. Because concurrent chemoradiotherapy offers superior treatment results compared to radiotherapy alone in patients with localized esophageal cancer, to improve survival rates, we treated patients displaying postoperative regional lymph node recurrence of esophageal squamous cell carcinoma using radiotherapy combined with protracted low-dose continuous infusion of 5-fluorouracil (5-FU). Between January 1992 and December 2001, 14 patients with postoperative regional lymph node recurrence of esophageal squamous cell carcinoma were treated with concurrent chemoradiotherapy. Radiotherapy was delivered at 1.8–2.0 Gy/day, for a total dose of 56–70 Gy (median, 60 Gy). Chemotherapy was administered 5 days/week as continuous infusion of 5-FU (250–300 mg/m2) for at least 5 weeks. Median follow-up time was 27 months. Twelve patients demonstrated partial response, and 2 patients displayed stable disease. Response rate was therefore 86% (12/14). In-field recurrence occurred in 3 patients. Involved lymph nodes that recurred in the irradiation field were ≥40 mm in maximum diameter and invaded into the surrounding normal tissues. Local progression-free rate at 2 years was 72%. As an initial failure, 6 patients displayed out-field recurrence. Disease progression-free rate at 2 years was 42%. Overall survival rates at 1 and 2 years were 85% and 57%, respectively. Concurrent chemoradiotherapy using low-dose continuous infusion of 5-FU was effective for patients with postoperative regional lymph node recurrence of esophageal squamous cell carcinoma. Close follow-up is crucial, and further investigation is required to prevent out-field recurrence.