The impact of histology on recurrence patterns in esophageal cancer treated with definitive chemoradiotherapy

Radiother Oncol. 2017 Aug;124(2):318-324. doi: 10.1016/j.radonc.2017.06.019. Epub 2017 Jul 4.

Abstract

Background: To assess the impact of histology on recurrence patterns and survival outcomes in patients with esophageal cancer (EC) treated with definitive chemoradiotherapy (CRT).

Methods: We analyzed 590 consecutive EC patients who received definitive CRT from 1998 to 2014, including 182 patients (30.8%) with squamous cell carcinoma (SCC) and 408 (69.2%) with adenocarcinoma. Recurrence pattern and timing, survival, and potential prognostic factors were compared.

Results: After a median follow-up time of 58.0months, the SCC group demonstrated a comparable locoregional recurrence rate (42.9% vs. 38.0%, P=0.264) but a significantly lower distant failure rate (27.5% vs. 48.0%, P<0.001) than adenocarcinoma group. No significant difference was found in overall survival or locoregional failure-free survival between groups, whereas the SCC group was associated with significantly more favorable recurrence-free survival (P=0.009) and distant metastasis-free survival (P<0.001). The adenocarcinoma group had higher hematogenous metastasis rates of bone, brain, and liver, whereas the SCC group had a marginally higher regional recurrence rate. Among patients who received salvage surgery after locoregional recurrence, no significant difference in survival was found between groups (P=0.12).

Conclusions: The patterns and sites of recurrence, survival outcomes, and prognostic factors were significantly different between esophageal SCC and adenocarcinoma.

Keywords: Definitive chemoradiotherapy; Esophageal cancer; Histology; Recurrence; Survival.

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / radiotherapy
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / drug therapy
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / radiotherapy
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy
  • Cisplatin / administration & dosage
  • Esophageal Neoplasms / drug therapy
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / radiotherapy
  • Esophageal Neoplasms / therapy*
  • Esophageal Squamous Cell Carcinoma
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology
  • Retrospective Studies
  • Salvage Therapy
  • Young Adult

Substances

  • Cisplatin