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Patterns of recurrence after trimodality therapy for esophageal cancer
Author(s) -
Dorth Jennifer A.,
Pura John A.,
Palta Manisha,
Willett Christopher G.,
Uronis Hope E.,
D'Amico Thomas A.,
Czito Brian G.
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28703
Subject(s) - medicine , esophagus , esophageal cancer , chemoradiotherapy , lymph node , esophagectomy , cancer , adenocarcinoma , radiation therapy , stage (stratigraphy) , survival rate , anastomosis , paraaortic lymph nodes , supraclavicular lymph nodes , carcinoma , radiology , surgery , gastroenterology , metastasis , paleontology , biology
BACKGROUND Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined. METHODS All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery. RESULTS Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow‐up was 1.3 years. The 2‐year locoregional control, event‐free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2‐year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2‐year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥ 2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%). CONCLUSIONS Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes. Cancer 2014;120:2099–2105 . © 2014 American Cancer Society .