Torii Akira, Tomita Natsuo, Takaoka Taiki, Kondo Takuhito, Yamamoto Shintaro, Sugie Chikao, Nagai Aiko, Miyakawa Akifumi, Kuno Mayu, Uchiyama Kaoru, Otsuka Shinya, Ogawa Yasutaka, Takano Seiya, Kita Nozomi, Tanaka Tatsuya, Ogawa Ryo, Kubota Eiji, Takiguchi Shuji, Kataoka Hiromi, Hiwatashi Akio
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Department of Radiology, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya, Aichi 454-8502, Japan.
Jpn J Clin Oncol. 2025 Jan 8;55(1):59-66. doi: 10.1093/jjco/hyae124.
There is no consensus on the optimal treatment for patients with locoregional recurrence of esophageal cancer after surgery. The objective of this study was to investigate the outcomes and prognostic factors associated with salvage radiotherapy in patients with locoregional recurrence of esophageal cancer after surgery.
We reviewed 80 patients with locoregional recurrence of esophageal cancer after surgery who were treated with radiotherapy. The median dose was 60 Gy, and 29 patients (36%) received elective nodal irradiation. Fifty-three patients (66%) received concurrent chemotherapy (mostly 5-fluorouracil and cisplatin) during radiotherapy. Overall survival, progression-free survival and in-field recurrence rate were assessed.
The median follow-up period was 17 months. Two-year overall survival, progression-free survival and in-field recurrence rate were 50.3%, 23.5% and 41.3%, respectively. On multivariate analysis, a maximum diameter of locoregional recurrence lesions <30 mm was associated with higher overall survival (P = 0.044). Disease-free interval between surgery and locoregional recurrence >14 months was associated with higher PFS (P = 0.003). Late grade 3 toxicities occurred in three patients (3.8%). No grade 4 or higher toxicity was observed.
Salvage radiotherapy demonstrated efficacy in achieving in-field control with acceptable toxicity. However, the high rate of out-of-field metastases led to poor progression-free survival and overall survival, particularly in cases involving large lesions and a short disease-free interval. A prospective study is warranted to establish a treatment strategy, particularly considering the combined use of effective anti-cancer drugs.
对于食管癌术后局部区域复发患者的最佳治疗方案，目前尚无共识。本研究的目的是调查食管癌术后局部区域复发患者挽救性放疗的疗效及预后因素。
我们回顾性分析了80例食管癌术后局部区域复发并接受放疗的患者。中位剂量为60 Gy，29例患者（36%）接受了选择性淋巴结照射。53例患者（66%）在放疗期间接受了同步化疗（主要为氟尿嘧啶和顺铂）。评估总生存期、无进展生存期和野内复发率。
中位随访期为17个月。两年总生存期、无进展生存期和野内复发率分别为50.3%、23.5%和41.3%。多因素分析显示，局部区域复发灶最大直径<30 mm与较高的总生存期相关（P = 0.044）。手术至局部区域复发的无病间期>14个月与较高的无进展生存期相关（P = 0.003）。3例患者（3.8%）出现3级晚期毒性反应。未观察到4级或更高等级的毒性反应。
挽救性放疗在实现野内控制方面显示出疗效，且毒性可接受。然而，野外转移率较高导致无进展生存期和总生存期较差，尤其是在病变较大和无病间期较短的病例中。有必要开展前瞻性研究以制定治疗策略，特别是考虑联合使用有效的抗癌药物。
