Therapeutic strategy to prevent the recurrence of esophageal carcinoma after radical resection

Objective: To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical re- section and determine relevant prognostic factors. Methods: A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial sur- gery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treat- ed with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator. Results: The median survival period after recurrence was 14.3 months (95% CI = 12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P = 0.032). Univariate analysis results showed the following prognostic factors: tumor location before surgery; operation mode; whether or not recurrence was detected with distant metastases; and therapy af- ter recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor. Conclu- sion: Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant me- tastases treated with chemotherapy may initially benefit from a longer survival rate.