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. 2018 Sep 10;13(1):171.
doi: 10.1186/s13014-018-1122-y.

Survival benefit of re-irradiation in esophageal Cancer patients with Locoregional recurrence: a propensity score-matched analysis

Liang Hong  1 , Yun-Xia Huang  1 , Qing-Yang Zhuang  1 , Xue-Qing Zhang  1 , Li-Rui Tang  1 , Kai-Xin Du  2 , Xiao-Yi Lin  2 , Bu-Hong Zheng  1 , Shao-Li Cai  3 , Jun-Xin Wu  1 , Jin-Luan Li  4
Affiliations

Survival benefit of re-irradiation in esophageal Cancer patients with Locoregional recurrence: a propensity score-matched analysis

Liang Hong et al. Radiat Oncol. .

Abstract

Background: To investigate the treatment failure pattern and factors influencing locoregional recurrence of esophageal squamous cell carcinoma (ESCC) and examine patient survival with re-irradiation (re-RT) after primary radiotherapy.

Methods: We retrospectively analyzed 87 ESCC patients treated initially with radiotherapy. Failure patterns were classified into regional lymph node recurrence only (LN) and primary failure with/without regional lymph node recurrence (PF). Patients received either re-RT or other treatments (non-re-RT group). Baseline covariates were balanced by a propensity score model. Overall survival (OS) and toxicities were assessed as outcomes.

Results: The median follow-up time was 87 months. Thirty-nine patients received re-RT. Failure pattern and re-RT were independent prognostic factors for OS (P = 0.040 and 0.015) by Cox multivariate analysis. Re-RT with concomitant chemotherapy showed no survival benefit over re-RT alone (P = 0.70). No differences in characteristics were found between the groups by Chi-square tests after propensity score matching. The Cox model showed that failure pattern and re-RT were prognostic factors with hazard ratios (HR) of 0.319 (P = 0.025) and 0.375 (P = 0.002), respectively, in the matched cohort. Significant differences in OS were observed according to failure pattern (P = 0.004) and re-RT (P < 0.001). In the re-RT and non-re-RT groups, 9.09% and 3.03% of patients experienced tracheoesophageal fistulas, and 15.15% and 3.03% of patients developed pericardial/pleural effusion, respectively (P > 0.05). The incidence of radiation pneumonitis was higher in the re-RT group (24.24% vs. 6.06%, P = 0.039), but no cases of pneumonia-related death occurred.

Conclusions: Re-RT improved long-term survival in patients with locoregional recurrent ESCC. Despite a high incidence of radiation pneumonitis, toxicities were tolerable.

Keywords: Esophageal squamous cell carcinoma; Locoregional recurrence; Overall survival; Propensity score-matched analysis; Re-irradiation.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Fujian Medical University Cancer Hospital, Fuzhou, China (KT2018–006-01).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Time to locoregional recurrence after initial treatment for 87 ESCC patients
Fig. 2
Fig. 2
Kaplan–Meier analysis of OS according to (a) failure pattern (LN vs. PF, P = 0.004) before matching; (b) re-irradiation (re-RT vs. without re-RT, P < 0.001) before matching; (c) failure pattern (LN vs. PF, P = 0.004) after matching; and (d) re-irradiation (re-RT group vs. non-re-RT group, P < 0.001) after matching
Fig. 3
Fig. 3
Patient survival after re-RT with or without chemotherapy
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