Outcomes of solitary postoperative recurrence of esophageal squamous cell carcinoma diagnosed with FDG-PET/CT and treated with definitive radiation therapy

Hiroki Ihara; Kotaro Yoshio; Shunsuke Tanabe; Soichi Sugiyama; Masashi Hashimoto; Naoaki Maeda; Shinsuke Akagi; Soshi Takao; Kazuhiro Noma; Takao Hiraki

doi:10.1007/s10388-023-01000-4

Outcomes of solitary postoperative recurrence of esophageal squamous cell carcinoma diagnosed with FDG-PET/CT and treated with definitive radiation therapy

Esophagus. 2023 Jul;20(3):548-556. doi: 10.1007/s10388-023-01000-4. Epub 2023 Apr 7.

Authors

Affiliations

¹ Department of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. ihara.hiroki.0206@gmail.com.
² Department of Proton Beam Therapy, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
³ Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
⁴ Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
⁵ Department of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Abstract

Background: Surgical resection of esophageal cancer is frequently performed to achieve a complete cure. However, the postoperative recurrence rate is 36.8-42.5%, leading to poor prognosis. Radiation therapy has been used to treat recurrences; solitary recurrence has been proposed as a prognostic factor for radiation therapy, though its significance is unclear. ¹⁸F-fluorodeoxyglucose positron emission tomography is a highly accurate diagnostic modality for esophageal cancer. This retrospective study aimed to analyze the outcomes of solitary postoperative recurrences of esophageal squamous cell carcinoma diagnosed with ¹⁸F-fluorodeoxyglucose positron emission tomography and treated with definitive radiation therapy.

Methods: We examined 27 patients who underwent definitive radiation therapy for single or multiple postoperative recurrences of esophageal squamous cell carcinoma between May 2015 and April 2021. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography was performed within 3 months before the commencement of radiation therapy. Kaplan-Meier, univariate, and multivariate analyses were performed to examine the overall survival and identify potential prognostic factors.

Results: The 1-, 2-, and 3-year overall survival rates were 85.2%, 62.6%, and 47.3%, respectively, and solitary recurrence was the only significant factor associated with overall survival (P = 0.003). The 1-, 2-, and 3-year overall survival rates in patients with solitary recurrence were 91.7%, 80.2%, and 80.2%, respectively, and in patients with multiple recurrences they were 80.0%, 50.3%, and 25.1%, respectively. Multivariate analysis also showed solitary recurrence as a significant factor for overall survival.

Conclusions: When diagnosed with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography, solitary recurrence appears to have a more favorable prognosis than multiple recurrences.

Keywords: 18F-fluorodeoxyglucose positron emission tomography; Esophageal squamous cell carcinoma; Radiation therapy; Recurrence; Survival.

MeSH terms

Carcinoma, Squamous Cell* / diagnostic imaging
Carcinoma, Squamous Cell* / radiotherapy
Carcinoma, Squamous Cell* / surgery
Esophageal Neoplasms* / diagnosis
Esophageal Neoplasms* / radiotherapy
Esophageal Squamous Cell Carcinoma* / diagnosis
Esophageal Squamous Cell Carcinoma* / radiotherapy
Fluorodeoxyglucose F18
Humans
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography
Recurrence
Retrospective Studies

Substances

Fluorodeoxyglucose F18