Failure patterns after adjuvant chemoradiotherapy following endoscopic resection for superficial esophageal squamous cell carcinoma

• Published in: Cancer medicine (Malden, MA) Vol. 8; no. 10; pp. 4547 - 4554
• Main Authors: Ikawa, Toshiki, Ishihara, Ryu, Konishi, Koji, Morimoto, Masahiro, Hirata, Takero, Kanayama, Naoyuki, Yamamoto, Sachiko, Matsuura, Noriko, Wada, Kentaro, Hayashi, Kenji, Ogawa, Kazuhiko, Teshima, Teruki
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2019; John Wiley and Sons Inc; Wiley
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Cancer therapies; Chemoradiotherapy; Chemoradiotherapy, Adjuvant - methods; Chemotherapy; Classification; Clinical Cancer Research; Computed tomography; endoscopic resection; Endoscopy; Esophageal cancer; Esophageal carcinoma; esophageal neoplasms; Esophageal Neoplasms - therapy; Esophageal Squamous Cell Carcinoma - therapy; Esophagectomy - methods; Esophagus; Female; Humans; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymphatic system; Male; Medical records; Metastases; Metastasis; Middle Aged; Original Research; Patients; Radiation therapy; Retrospective Studies; Squamous cell carcinoma; Survival Analysis; Treatment Failure; Tumors; Japan; chemoradiotherapy; endoscopic resection; esophageal neoplasms; squamous cell carcinoma
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.2365

Background This study evaluated the locations of lymph node recurrence and their association with irradiation fields used for radiotherapy after adjuvant chemoradiotherapy following endoscopic resection for superficial esophageal squamous cell carcinoma. Methods Medical records of 96 consecutive patients with superficial esophageal squamous cell carcinoma who underwent adjuvant chemoradiotherapy following endoscopic resection were reviewed. Computed tomography was used to identify whether nodal recurrences were within the elective nodal irradiation field. The cumulative incidence of recurrence was calculated, accounting for death as a competing risk. Univariate and multivariate analyses identified factors predicting nodal recurrence. Results The median follow‐up period was 61 months (range: 6‐137 months). Seven patients (7.3%) developed lymph node recurrence only; two patients (2.1%) developed nodal plus local recurrence. Six of the seven cases without local recurrence involved the elective nodal irradiation field, with five cases involving the recurrent nerve lymph nodes. The 5‐year cumulative incidence of lymph node recurrence was higher for T1b tumors with lymphovascular invasion than for T1a tumors with lymphovascular invasion (17.6% vs 6.2%, P = 0.086; HR: 3.74, 95% CI: 0.80‐17.52, P = 0.094) and T1b tumors without lymphovascular invasion (17.6% vs 3.3%, P = 0.031; HR: 6.78, 95% CI: 0.80‐57.63, P = 0.080). Conclusions Lymph node recurrence frequently involved the elective nodal irradiation field, with recurrent nerve lymph nodes being common metastasis sites. The high incidence of nodal recurrence for T1b tumors with lymphovascular invasion highlights a need for new strategies for treating this subset of superficial esophageal squamous cell carcinomas. This study evaluated the locations of lymph node recurrence and their association with irradiation fields used for radiotherapy after adjuvant chemoradiotherapy following endoscopic resection for superficial esophageal squamous cell carcinoma. There is a high incidence of nodal recurrence for T1b tumors with lymphovascular invasion. New strategies for treating this subset of superficial esophageal squamous cell carcinomas are required.