To investigate the prognostic factors of esophageal squamous cell carcinoma (ESCC) with locoregional recurrence and to explore whether re-irradiation(re-RT) improves outcomes.
We retrospectively analyzed 87 ESCC patients with locoregional recurrence. All patients received radiotherapy in the initial treatment. The failure patterns were classified into regional lymph node recurrence only (LN) and local failure with/without regional lymph node recurrence (LF). A propensity score model was utilized to balance baseline covariates: RT group (n = 33) comprising patients who underwent re-RT and non-RT group (n = 33) without re-RT. Outcomes measure including overall survival (OS) and toxicities.
Median follow-up was 87 months (range 2-206). Of the 87 included patients, 39 received re-RT. Failure pattern and re-RT were the independent prognostic factors of OS (P = 0.040 and 0.015) by Cox multivariate analysis. Further subgroup analysis did not demonstrate a survival benefit with re-RT combined with chemotherapy as compared to re-RT alone (P = 0.70). After propensity score matching, no differences were found between two groups’ characteristics by Chi-square tests. Similarly, Cox model demonstrated failure pattern and re-RT as the prognostic factors, with hazard ratio (HR) 0.319 (95% confidence interval [CI] 0.117–0.869, P = 0.025) and HR 0.375 (95% CI 0.201–0.701, P = 0.002) in the matched chort. Also, significant differences in OS (P = 0.004) were presented in failure pattern (LN vs. LF, P = 0.004) and re-RT (RT vs. non-RT, P < 0.001). In terms of toxicities, there were 9.09% and 3.03% of tracheoesophageal fistulas, 15.15% and 3.03% of pericardial/pleural effusion in the RT and non-RT group, respectively (P > 0.05). The RT group had a higher rate of radiation pneumonitis (24.24% vs. 6.06%, P = 0.039), but no pneumonia related deaths occurred.
Re-irradiation might improve the long-term prognosis of locoregional recurrent ESCC with a radiation history. Though the radiation pneumonitis is more frequent, re-irradiation is well tolerated.
Clinical trial identification
Legal entity responsible for the study
National Clinical Key Specialty Construction Program.
All authors have declared no conflicts of interest.