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. 2019 Jun;10(3):483-491.
doi: 10.21037/jgo.2019.01.26.

Adjuvant radiotherapy in oesophageal cancer with positive circumferential resection margins-recurrence and survival outcomes

Bhamini Vadhwana  1 , Dimitrios Zosimas  1 , Panagis M Lykoudis  2 , Huan Ming Phen  1 , Maria Martinou  3 , Thangadorai Amalesh  1 , David Khoo  1
Affiliations

Adjuvant radiotherapy in oesophageal cancer with positive circumferential resection margins-recurrence and survival outcomes

Bhamini Vadhwana et al. J Gastrointest Oncol. 2019 Jun.

Abstract

Background: The role of adjuvant radiotherapy in patients with microscopically positive circumferential resection margins (CRM), R1 specimen, in oesophageal resections for cancer with curative intent remains unclear. However, R1 specimens are associated with poorer survival outcomes. The aim was to assess the benefit of adjuvant radiotherapy on recurrence and survival in these patients.

Methods: Patients were identified in a single centre between July 2000 and December 2016. Patient demographics, tumour characteristics and survival outcomes were assimilated and compared between those who received adjuvant therapy and those who did not.

Results: Sixty-eight patients were included in the study; 57 (83.8%) male and 11 (16.2%) female with a median age of 67 years. The adjuvant radiotherapy regimen used was 40-50 Gy in 25 fractions over 5 weeks. Median follow-up was 13 months (interquartile range, 6-27 months). Twenty-five (36.8%) patients received adjuvant radiotherapy. There was no statistically significant correlation between administration of adjuvant radiotherapy and local recurrence (P=0.148), distant metastases (P=0.605), overall disease progression (P=0.561), progression-free survival (P=0.663) and overall survival (P=0.538).

Conclusions: This study detects no benefit to oncological outcomes with the use of adjuvant radiotherapy in patients with microscopically positive CRM. Larger randomized studies are needed to further confirm these results.

Keywords: Oesophageal cancer; radiotherapy; survival.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart demonstrating inclusion criteria for this study.
Figure 2
Figure 2
Bar chart comparing local recurrence in patients receiving adjuvant radiotherapy for positive circumferential resection margins.
Figure 3
Figure 3
Bar chart comparing distant metastases in patients receiving adjuvant radiotherapy for positive circumferential resection margins.
Figure 4
Figure 4
Bar chart comparing disease progression in patients receiving adjuvant radiotherapy for positive circumferential resection margins.
Figure 5
Figure 5
Kaplan-Meier graph showing no significant difference in progression-free survival between patients with positive CRM who received adjuvant radiotherapy (25 months; IQR, 9–26 months) and those who did not (13 months; IQR, 6–29 months). CRM, circumferential resection margins; IQR, interquartile range.
Figure 6
Figure 6
Kaplan-Meier graph showing no significant difference in overall survival between patients with positive CRM who received adjuvant radiotherapy (22 months; IQR, 14–40 months) and those who did not (19 months; IQR, 10–41 months). CRM, circumferential resection margins; IQR, interquartile range.
See this image and copyright information in PMC

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