PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): There was no consensus on the treatment of recurrent esophageal cancer after radiotherapy. Our study aimed to explore whether re-irradiation improves outcomes in recurrent esophageal cancer after primary definitive radiotherapy.
Materials/Methods: We respectively analyzed 70 patients with recurrent esophageal cancer who were treated at our institution, from June 2000 to June 2014. Propensity score matching was used to create patient groups that were balanced across several covariates (age, gender, smoke, drink and primary location). The patients were divided into two groups: a re-irradiation group comprising patients who underwent re-radiotherapy (re-RT) and a palliative group, comprising a control group of patients who underwent palliative therapy without re-RT. Outcomes measure included overall survival (OS) and toxicities.
Results: The median follow-up was 87 months (range 2-206). The median doses of primary radiotherapy for re-irradiation group and palliative group were 60 Gy (range 40-73) and 66 Gy (range 50-76), respectively. And the median dose was 50 Gy (range 21-70) for re-RT. In our follow-up, all the patients in the palliative group died, while seven patients remained alive in the re-irradiation group. The 1, 3, 5-year OS in the re-irradiation group and palliative group were 65.9% vs. 28.6%, 24.6% vs. 2.9% and 14.1% vs. 0%, respectively (P < 0.001). Their median OS was 16 months (range, 2-85) and six months (range, 1-60), respectively. Further subgroup analysis did not demonstrate a survival benefit with chemoRT as compared to re-RT alone for recurrent esophageal cancer (P = 0.75). The univariate analysis showed that re-irradiation was the independent prognosis factor for recurrent esophageal cancer (P < 0.001). Regarding toxicities, there were 3 (8.57%) and 2 (5.71%) cases of tracheoesophageal fistulas, 7 (20%) and 1 (2.85%) cases of pericardial/pleural effusion in the re-irradiation group and palliative group, respectively(P＞0.05). The re-irradiation group had a higher rate of radiation pneumonitis (22.8% vs. 5.71%, P = 0.040), but no pneumonia-related deaths occurred.
Conclusion: Re-irradiation could improve the long-term prognosis of recurrent esophageal cancer after primary definitive RT. Though the radiation pneumonitis is more frequent in the re-irradiation group, re-irradiation is well tolerated.
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