EFFICACY AND SAFETY OF CHEMORADIOTHERAPY FOR PATIENTS WITH LOCOREGIONAL LYMPH NODE RECURRENCE OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA

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Abstract

Background

Although no standard treatment has been established for recurrent esophageal cancer, several studies have suggested the efficacy of chemoradiotherapy (CRT) for the locoregional lymph node recurrence of esophageal squamous cell carcinoma (ESCC).

Objective

The aim of this study is to evaluate the efficacy and safety of CRT for patients with the locoregional lymph node recurrence of ESCC.

Patients and methods

Between 2002 and 2009, 167 consecutive patients with thoracic ESCC underwent curative esophagectomy at Shizuoka Cancer Center; of these patients, 41 were diagnosed as locoregional lymph node recurrence. We retrospectively reviewed the data of 30 patients who satisfied the following selection criteria: (i) PS 0–1; (ii) adequate organ function; (iii) no previous radiotherapy (RT) and (iv) concurrent CRT by split regimen (two courses of 5-FU 400 mg/m2 on days 1–5 and 8–12 + CDDP 40 mg/m2 on days 1 and 8 and RT 60 Gy/30 fr for 8 weeks with a 2-week break) or continuous regimen (two courses of 5-FU 700 mg/m2 on days 1–4 + CDDP 70 mg/m2 on day 1 and RT 60 Gy/30 fr for 6 weeks).

Results

The characteristics of the 30 patients were as follows: median age, 65 years (range: 44–77 ); men/women, 29/1; PS (0/1), 20/10; primary tumor location (upper/middle/lower), 4/19/7; cStage (UICC 6th edition) (I/IIA/IIB/III/IVA/IVB), 1/5/1/17/2/4; adjuvant chemotherapy (+/−), 20/10; site of recurrence (cervical/mediastinal/abdominal/other), 6/20/1/3; number of recurrent lymph nodes (1/ > 2), 18/12. The median time to recurrence from surgery is 11 months (range: 3–57) and 28 patients (93%) completed the planned CRT regimen. The median follow-up period is 25.5 months (range: 6.6–87.7). The complete response rate was 56.7%. The median PFS and the median OS were 9.1 and 22.3 months, respectively. The frequency of grade 3/4 adverse events (CTCAE ver4.0) was as follows: leukocytopenia (30%), neutropenia (23%), anemia (13%), appetite loss (17%) and nausea (7%). No treatment-related deaths occurred.

Conclusion

CRT is an effective and safe treatment option for the locoregional lymph node recurrence of ESCC.

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