Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer

J de Vos-Geelen; S M E Geurts; G A P Nieuwenhuijzen; F E M Voncken; J A Bogers; P M Braam; C T Muijs; M A de Jong; N Kasperts; T Rozema; G J Blom; S A W Bouwense; L B J Valkenburg-van Iersel; P M Jeene; F J P Hoebers; V C G Tjan-Heijnen

doi:10.1016/j.ejso.2021.02.001

Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer

Eur J Surg Oncol. 2021 Aug;47(8):2016-2022. doi: 10.1016/j.ejso.2021.02.001. Epub 2021 Feb 5.

Authors

J de Vos-Geelen¹, S M E Geurts², G A P Nieuwenhuijzen³, F E M Voncken⁴, J A Bogers⁵, P M Braam⁶, C T Muijs⁷, M A de Jong⁸, N Kasperts⁹, T Rozema¹⁰, G J Blom¹¹, S A W Bouwense¹², L B J Valkenburg-van Iersel², P M Jeene¹³, F J P Hoebers¹⁴, V C G Tjan-Heijnen²

Affiliations

¹ Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands. Electronic address: judith.de.vos@mumc.nl.
² Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands.
³ Dept. of Surgery, Catharina Hospital Eindhoven, P.O. box 1350, 5602, ZA, Eindhoven, the Netherlands.
⁴ Dept. of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, P.O. box 90203, 1006, BE, Amsterdam, the Netherlands.
⁵ Radiotherapiegroep Arnhem, P.O. box 60160, 6800, JD, Arnhem, the Netherlands.
⁶ Dept. of Radiotherapy, RadboudUMC, P.O. box 9101, 6500, HB, Nijmegen, the Netherlands.
⁷ Dept. of Radiation Oncology, University Medical Center Groningen, University of Groningen, P.O. box 11120, 9700, RB, Groningen, the Netherlands.
⁸ Dept. of Clinical Oncology, Leiden University Medical Centre, P.O. box 9699, 2300, RC, Leiden, the Netherlands.
⁹ Dept. of Radiotherapy, University Medical Center Utrecht, P.O. box 85500, 3508, GA, Utrecht, the Netherlands.
¹⁰ Insituut Verbeeten, P.O. box 90120, 5000, LA, Tilburg, the Netherlands.
¹¹ Dept. of Radiation Oncology, Amsterdam University Medical Centers, VU University, P.O. box 7057, 1007, MB, Amsterdam, the Netherlands.
¹² Dept. of Surgery, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands.
¹³ Dept. of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, P.O. box 22660, 1100, DD, Amsterdam, the Netherlands; Radiotherapiegroep Deventer, P.O. box 123, 7400, AC, Deventer, the Netherlands.
¹⁴ Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. box 3035, 6202, NA, Maastricht, the Netherlands.

PMID: 33583629
DOI: 10.1016/j.ejso.2021.02.001

Abstract

Introduction: The aim of this retrospective study was to determine the patterns of recurrence and overall survival (OS) in patients achieving clinical complete response after treatment with definitive chemoradiation (CRT) for proximal esophageal cancer.

Materials and methods: Patients with proximal esophageal cancer treated with CRT between 2004 and 2014 in 11 centers in the Netherlands were included. OS and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Cumulative incidence of first recurrence (locoregional or distant) and locoregional recurrence (LRR) were assessed using competing risk analyses.

Results: In 197 of the 200 identified patients, response was evaluated, 133 (68%) showed a complete response. In complete responders, median OS, three-year OS, and PFS were 45.0 months (95% CI 34.8-61.5 months), 58% (95% CI 48-66), and 49% (95% CI 40-57), respectively. Three- and five-year risk of recurrence were respectively 40% (95% CI 31-48), and 45% (95% CI 36-54). Three- and five-year risk of LRR were 26% (95% CI 19-33), and 30% (95% CI 22-38). Eight of 32 patients with an isolated LRR underwent salvage surgery, with a median OS of 32.0 months (95% CI 6.8-not reached).

Conclusion: In patients with a complete response after definitive CRT for proximal esophageal cancer, most recurrences were locoregional and developed within the first three years after CRT. These findings suggest to shorten locoregional follow-up from five to three years.

Keywords: Cervical; Chemoradiotherapy; Esophagus; Relapse; Squamous cell cancer; Upper thoracic.

MeSH terms

Adult
Aged
Aged, 80 and over
Antineoplastic Agents / therapeutic use*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Carboplatin / administration & dosage
Chemoradiotherapy / methods*
Cisplatin / therapeutic use
Disease-Free Survival
Esophageal Neoplasms / pathology
Esophageal Neoplasms / therapy*
Esophageal Squamous Cell Carcinoma / pathology
Esophageal Squamous Cell Carcinoma / therapy*
Esophagectomy
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local / epidemiology*
Neoplasm Recurrence, Local / therapy
Netherlands
Paclitaxel / administration & dosage
Progression-Free Survival
Radiotherapy
Retrospective Studies
Salvage Therapy
Time Factors

Substances

Antineoplastic Agents
Carboplatin
Paclitaxel
Cisplatin