| Background:Radical radiotherapy or radiochemotherapy has been proven effective and widely accepted for the patients who have esophageal carcinoma but failed to have surgeries for different reasons. But Local-regional recurrence is still the major type of treatment failure, and most of the patients relapse locally within 1 to 2 years after radical radiotherapy. For patients with locally recurrent esophageal cancer after previous radial radiotherapy, the limited second line treatment mainly includes surgery and palliative chemotherapy. Although re-irradiation has also been proven to be feasible and effective in other tumors, the feasibility and advantage of re-radiotherapy as a salvage treatment of REC after RCT remains uncertain and controversial.Objective:The aim of this study was to evaluate the feasibility and outcome of re-irradiation in patients with local recurrent esophageal cancer after primary radical radiotherapy or radiochemotherapy(RCT), to analyze and compare the effectiveness and complications of different treatments.Methods:A total of 52 patients with local recurrent esophageal squamous cell carcinoma after initial radical RT or RCT were retrospectively analyzed. All of them achieved CR after initial radical RT or RCT, and then local recurrences were identified in more than six months, and then they had received re-irradiation. Based on whether the re-irradiation was combined with chemotherapy, the REC patients were categorized into re-radiotherapy group (re-RT group) and radiochemotherapy group (RCT group). Analysis and comparison of effectiveness and incidence of complications between different treatment modalities, analysis of the relationship between different clinical pathological factors and survival after recurrence were retrospectively conducted. Statistical analyses were performed using the SPSS Statistics 19.0 software. The two treatment groups were compared to base-line characteristics, treatment effectiveness and the incidence of complications using a Chi-square test. The rates of survival curves, depending on different factors, were calculated using the Kaplan-Meier method, and were compared using a log-rank test. Cox’s proportional hazards regression model was used to determine the effect of multiple factors on survival. All statistical differences were considered significant when p value<0.05.Results:In the cohort, the number of patients who reached CR,PR, SD, and PD after re-irradiation were 10(19.2%),26 (50.0%),13 (25.0%),and 3(5.8%),respectively. The remission rates (RR) were 69.2% in the cohort,58.3% in RT group,and 71.4% in RCT group. The remission rate of the RCT group was higher than the re-RT group, but the difference had no statistical significance because p=0.331.21 patients (40.4%) from the cohort,9 patients (37.5%) from the re-RT group, and 12 patients (42.9%)from the RCT group showed 2-3 grade radiation-induced esophagitis.9 patients(17.3%)from the cohort,3 patients(12.5%)from the re-RT group, and 6 patients (21.4%) from the RCT group showed 2-3 grade radiation-induced pneumonitis.21 patients (40.4%) from the cohort,1 patients(4.2%)from the re-RT group, and 20 patients (71.4%) from the RCT group showed 2-3 grade bone marrow suppression. In addition, esophageal perforation was observed in 6 patients (11.5%) in the cohort,2 from the re-RT group (8.3%)and 4 from the RCT group (14.3%)respectively. Differences between the complication incidences from the two groups had no statistical significances, except that the incidence of bone marrow suppression was much higher from RCT group.The median survival time after recurrence was 11 months in all patients. The 1,2,3 year survival rates were 44.2%,11.5%, and 3.8% respectively in all patients. According to the result of univariate analysis, the interval time to recurrence, PS score before re-irradiation, combined chemotherapy to re-irradiation, and the dose of re-irradiation were the factors related to the survival time after recurrence. What’s more, PS score before re-irradiation and combined chemotherapy to re-irradiation were the independent factors according to the multivariate analysis.Conclusion:Re-irradiation may be feasible and effective for REC patients after previous radical radiotherapy. Patients who relapsed more than 1 year after the previous radiotherapy and had PS scored 0-1 before re-irradiation may get improved survival after recurrence, when the re-irradiation is combined with chemotherapy and the radiation dose≧50Gy. But the incidences of complications can be much higher, especially the severe ones, such as esophagus perforation, and that should be considered seriously. |
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