Salvage Re-Irradiation Versus-Concurrent Chemoradiotherapy For Esophageal Squamous Cell Carcinoma Patients With Locally Relapse After Definitive Chemoradiotherapy

Abstract

This retrospectively study aimed to investigate the effects of re-irradiation therapy (re-RT) and re-concurrent chemoradiotherapy (re-CCRT) with the precise radiation techniques for the patients with locally recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. From January 2008 to December 2016, 109 patients with locally recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy were involved in the study. Of all, patients with time to recurrence (TTR) over 24 months and ≤24 months were 36 (33.0%) and 73(77.0%) cases. Seventy-five (68.8%) patients had a recurrence of the esophagus and 34 (31.2%) patients suffered from local relapse and regional lymph node metastasis. Re-irradiation dose ranged from 45Gy to 61.2Gy. There were 79 (72.5%) patients treated with re-RT and 30 (27.5%) patients underwent re-CCRT. The objective response rates (ORRs) of the re-RT group and re-CCRT group were 62.0% and 70.0% (χ2 = 0.602, p = 0.438), and improvement rates of dysphagia (DIR) of the two groups were 65.7% and 56.0% (χ2 = 0.731, P = 0.393), respectively. The median survival time (MST) and 1-, 2-, 3-, 5-years survival rates in all patients were 8.0 months and 32.1%,16.5%, 8.3%, 3.7%, respectively. MST and 1-, 2-, 3-years survival rates were 8.0 months and 30.4%, 13.9%, 5.7% for re-RT versus 7.0 months and 33.3%, 23.3%, 16.6% for re-CCRT (χ2 = 2.085, p = 0.149). The MST in re-irradiation dose of ≤50Gy, >50to≤54Gy, and >54Gy groups were 6.0, 10.0 and 8.0 months, respectively (χ2 = 6.385, P = 0.041). The 1-, 2- and 3-years survival rates were 41.7%, 22.2% and 11.1% for patients with TTR over 24 months, which is significantly longer than those of 26.0%, 13.7% and 7.8% for patients with TTR ≤24 months (χ2 = 6.172, P = 0.013). Multivariate analysis showed that TTR was the independent factor for overall survival (hazard ratio, 0.573; 95% confidence interval, 0.365-0.900; P = 0.016).There was no significant difference between re-RT and re-CCRT groups in pneumonitis of grade ≥2, radiation esophagitis of grade 2-3 and the esophageal fistula (χ2 = 0.248, p = 0.619; χ2 = 0.509, P = 0.808; and χ2 = 0.030, P = 0.862). The morbidity of grade ≥2 myelosuppression was much lower in re-RT group than in re-CCRT group (3.7% vs 36.7%; χ2 = 18.151, p<0.001). Salvage re-irradiation therapy could be a treatment choice for patients with local relapse of esophagus after definitive chemoradiotherapy owing to ORR and improving dysphagia. However, overall survival still remains poor. Re-CCRT shows a higher toxicity of myelosuppression than re-RT. Re-radiation dose of >50 to ≤54Gy may be suitable for locally relapse patients as salvage. Patient with TTP over 24 months is a favorable factor for dim survival.