Highlights
- •Tumour recurrence is common after trimodality therapy for oesophageal cancer.
- •The most common pattern is distant recurrence with or without local recurrence.
- •In 58% of patients, various systemic therapies were initiated depending on histology.
- •Time to recurrence, recurrence sites and systemic therapy correlated with survival.
Abstract
Background
Recurrent oesophageal cancer after the initial curative multimodality treatment is
a disease condition with a poor prognosis. There is limited evidence on recurrence
patterns and on the optimal therapeutic approach.
Methods
We analysed the pattern of disease recurrence and subsequent therapies in patients
with recurrent oesophageal cancer based on prospectively collected data within a predefined
subproject of the randomised phase 3 trial Swiss Group for Clinical Cancer Research
(SAKK) 75/08.
Results
Among 300 patients included in the SAKK 75/08 trial, tumour recurrence was observed
in 103 patients with a median follow-up of 5.8 years. Locoregional recurrence only
was found in 26.2% of the patients, 21.4% of patients had both distant and locoregional
recurrence and 52.4% of patients had distant recurrence only. Fifty-nine patients
(58%) received at least one line of systemic therapy at recurrence, most commonly
oxaliplatin-based combination therapies for adenocarcinoma and single-agent chemotherapy
for squamous cell carcinoma. Local therapies, most commonly palliative radiotherapy,
were used in 49 patients (48%). Six patients underwent a second curative resection
or radiochemotherapy. We found no significant overall survival difference for isolated
locoregional recurrence versus distant recurrence (15.1 versus 8.7 months, p = 0.167).
In a multivariable Cox regression model, time from oesophagectomy to recurrence and
the number of recurrence sites as well as the use of systemic therapy or a second
curative local therapy significantly correlated with overall survival.
Conclusions
Recurrent oesophageal cancer remains a disease with a poor prognosis and requires
multidisciplinary management. A second curative approach for localised disease recurrence
may be an option for highly selected patients.
Keywords
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Article info
Publication history
Published online: November 08, 2022
Accepted:
September 30,
2022
Received in revised form:
September 29,
2022
Received:
March 24,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
