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Patterns of Recurrence in Locally Advanced Resectable Oesophageal Carcinoma: Retrospective Review from a Tertiary Cancer Centre in South India

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Abstract

Purpose

The study aims to analyse patterns of recurrence following neoadjuvant treatment and surgery in carcinoma oesophagus with an intent to postulate optimal nodal radiation.

Methodology

A retrospective review of patients who presented to our centre within a 5-year period (2014–2018), with recurrence following sequential neoadjuvant treatment and radical surgery, was conducted in this single-institution study. The patterns of recurrence and duration of disease-free survival were analysed.

Results

Twenty-one patients (14 men, 7 women) presented with recurrence, of which 13, 7, and 1 patient(s) had received NACT, NACTRT, or both, respectively. Six patients who did not receive neoadjuvant radiotherapy received adjuvant RT. Among the 10 patients who had nodal recurrence after RT (either neoadjuvant or adjuvant), 6 and 4 patients had in-field and out-of-field nodal recurrences, respectively—the latter were equally distributed within 5 cm and outside 5 cm of the PTV margin.

Conclusion

Among the patients who presented with recurrence, more than half had not received neoadjuvant RT (treated in the ‘pre-CROSS era’ or due to long-segment disease), reasserting the therapeutic superiority of NACTRT. Increased regularity of recurrences in the draining nodal region was not noted in this study, but large-scale, prospective, randomised head-to-head comparative trials to determine optimal nodal irradiation in carcinoma oesophagus are required.

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Data Availability

Data is unavailable for public access.

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  Google Scholar 

  2. Esophageal cancer [Internet]. India Cancer. [cited 2020 Mar 1]. Available from: http://cancerindia.org.in/esophagus-cancer/.

  3. Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA, Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA. 1999;281:1623–7.

    CAS  PubMed  Google Scholar 

  4. Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:1086–92.

    Article  CAS  Google Scholar 

  5. Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16:1090–8.

    Article  Google Scholar 

  6. Meguid RA, Hooker CM, Taylor JT, Kleinberg LR, Cattaneo SM, Sussman MS, et al. Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: does the pattern of recurrence differ for complete responders and those with partial or no response? J Thorac Cardiovasc Surg. 2009;138:1309–17.

    Article  Google Scholar 

  7. Shaikh T, Zaki MA, Dominello MM, Handorf E, Konski AA, Cohen SJ, Shields A, Philip P, Meyer JE Patterns and predictors of failure following tri-modality therapy for locally advanced esophageal cancer. Acta Oncol. Taylor & Francis; 2016;55:303–308.

  8. Koshy M, Greenwald BD, Hausner P, Krasna MJ, Horiba N, Battafarano RJ, et al. Outcomes after trimodality therapy for esophageal cancer: the impact of histology on failure patterns. Am J Clin Oncol. 2011;34:259–64.

    Article  Google Scholar 

  9. Xi M, Yang Y, Zhang L, Yang H, Merrell KW, Hallemeier CL, et al. Multi-institutional analysis of recurrence and survival after neoadjuvant chemoradiotherapy of esophageal cancer: impact of histology on recurrence patterns and outcomes. Ann Surg. 2019;269:663–70.

    Article  Google Scholar 

  10. van Hagen P, Wijnhoven BPL, Nafteux P, Moons J, Haustermans K, De Hertogh G, et al. Recurrence pattern in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer. Br J Surg. 2013;100:267–73.

    Article  Google Scholar 

  11. Barbetta A, Sihag S, Nobel T, Hsu M, Tan KS, Bains M, et al. Patterns and risk of recurrence in patients with esophageal cancer with a pathologic complete response after chemoradiotherapy followed by surgery. J Thorac Cardiovasc Surg. Elsevier; 2019;157:1249–1259.e5.

  12. Shen. Analysis of failure patterns in patients with resectable esophageal squamous cell carcinoma receiving chemoradiotherapy [Internet]. [cited 2020 Mar 5]. Available from: http://www.cancerjournal.net/article.asp?issn=0973-1482;year=2016;volume=12;issue=1;spage=62;epage=68;aulast=Shen.

  13. Yamashita H, Takenaka R, Omori M, Imae T, Okuma K, Ohtomo K, et al. Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institutional retrospective study. Radiat Oncol. 2015;10:171.

    Article  Google Scholar 

  14. Li Q, Zhu S, Li S, Deng W. Elective nodal irradiation provides a superior therapeutic modality for lymph node positivity esophageal squamous cell carcinoma patients receiving definitive radiotherapy versus involved-field irradiation. Medicine (Baltimore) [Internet]. 2019 [cited 2019 Sep 25];98. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370116/.

  15. Liu T, Ding S, Dang J, Wang H, Chen J, Li G. Elective nodal irradiation versus involved-field irradiation in patients with esophageal cancer receiving neoadjuvant chemoradiotherapy: a network meta-analysis. Radiat Oncol. 2019;14:176.

    Article  Google Scholar 

  16. Wu S-X, Wang L-H, Luo H-L, Xie C-Y, Zhang X-B, Hu W, et al. Randomised phase III trial of concurrent chemoradiotherapy with extended nodal irradiation and erlotinib in patients with inoperable oesophageal squamous cell cancer. Eur J Cancer Elsevier. 2018;93:99–107.

    Article  CAS  Google Scholar 

  17. Cheng Y, Jing S, Zhu L, Wang J, Wang L, Liu Q, et al. Comparison of elective nodal irradiation and involved-field irradiation in esophageal squamous cell carcinoma: a meta-analysis. J Radiat Res (Tokyo). 2018;59:604–15.

    Article  Google Scholar 

  18. van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, van Henegouwen, MIB, Wijnhoven, BPL, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer [Internet]. https://doi.org/10.1056/NEJMoa1112088. Massachusetts Medical Society; 2012 [cited 2020 Jul 1]. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1112088.

  19. Wu AJ, Bosch WR, Chang DT, Hong TS, Jabbour SK, Kleinberg LR, et al. Expert consensus contouring guidelines for IMRT in esophageal and gastroesophageal junction cancer. Int J Radiat Oncol Biol Phys. NIH Public Access. 2015;92:911.

    Article  Google Scholar 

  20. Fang W, Li Z, Mao T, Liu J, Guo X. Oesophagus. UICC Man Clin Oncol. John Wiley & Sons, Ltd; 2015 [cited 2020 Jul 2]. p. 280–96. https://doi.org/10.1002/9781119013143.ch25

  21. Samarasam I. Esophageal cancer in India: current status and future perspectives Samarasam I - Int J Adv Med Health Res [Internet]. [cited 2019 Sep 25]. Available from: http://www.ijamhrjournal.org/article.asp?issn=2349-4220;year=2017;volume=4;issue=1;spage=5;epage=10;aulast=Samarasam.

  22. Cherian JV, Sivaraman R, Muthusamy AK, Jayanthi V. Carcinoma of the esophagus in Tamil Nadu (South India): 16-year trends from a tertiary center. J Gastrointest Liver Dis JGLD. 2007;16:245–9.

    Google Scholar 

  23. Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 2017;6:119–30.

    Article  Google Scholar 

  24. Rizk N, Ishwaran H, Rice T, Chen L-Q, Schipper P, Kesler K, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251:46–50.

    Article  Google Scholar 

  25. Shridhar R, Hoffe SE, Almhanna K, Weber JM, Chuong MD, Karl RC, et al. Lymph node harvest in esophageal cancer after neoadjuvant chemoradiotherapy. Ann Surg Oncol. 2013;20:3038–43.

    Article  Google Scholar 

  26. Miyata H, Yamasaki M, Makino T, Miyazaki Y, Takahashi T, Kurokawa Y, et al. Therapeutic value of lymph node dissection for esophageal squamous cell carcinoma after neoadjuvant chemotherapy. J Surg Oncol. 2015;112:60–5.

    Article  Google Scholar 

  27. Knight WRC, Zylstra J, Hemelrijck MV, Griffin N, Jacques AET, Maisey N, et al. Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy. BJS Open. 2017;1:182–90.

    Article  CAS  Google Scholar 

  28. Wu S-G, Dai M-M, He Z-Y, Sun J-Y, Lin H-X, Lin H, et al. Patterns of regional lymph node recurrence after radical surgery for thoracic esophageal squamous cell carcinoma. Ann Thorac Surg. 2016;101:551–7.

    Article  Google Scholar 

  29. Liu Q, Cai X-W, Wu B, Zhu Z-F, Chen H-Q, Fu X-L. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy. PLoS One. 2014;9:e97225.

    Article  Google Scholar 

  30. Chen X-L, Chen T-W, Fang Z-J, Zhang X-M, Li Z-L, Li H, et al. Patterns of lymph node recurrence after radical surgery impacting on survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma. J Korean Med Sci. 2014;29:217–23.

    Article  Google Scholar 

  31. Cai W-J, Xin P-L. Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2010;96:104–7.

    Article  Google Scholar 

  32. Dorth JA, Pura JA, Palta M, Willett CG, Uronis HE, D’Amico TA, et al. Patterns of recurrence after trimodality therapy for esophageal cancer. Cancer. 2014;120:2099–105.

    Article  Google Scholar 

  33. Zhang X, Yu J, Li M, Zhu H. Details of out-field regional recurrence after involved-field irradiation with concurrent chemotherapy for locally advanced esophageal squamous cell carcinoma. OncoTargets Ther. 2016;9:3049–57.

    CAS  Google Scholar 

  34. Esophageal Cancer Recurrence Patterns and Implications for Surveillance [Internet]. [cited 2020 Mar 5]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066875/#!po=65.7895.

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Acknowledgments

BS would like to thank Dr. H Thomas for technical editing, language editing, and proofreading this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Ida B. Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Anindita Das, Manu Mathew, Rajesh Isiah, Subhashini John, Simon Pavamani & Balu Krishna Sasidharan

  2. Department of Upper GI Surgery, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Suraj Surendran, Myla Yacob & Inian Samarasam

  3. Division of Clinical Radiology, Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Aparna Irodi

  4. Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Ashish Singh & Anjana Joel

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  1. Anindita Das
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Correspondence to Balu Krishna Sasidharan.

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The authors declare that that they no conflict of interest.

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Ethical approval was waived by the local ethics committee of the institutional review board given the retrospective nature of the study.

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All authors consent to the publication of the manuscript in Journal of Gastrointestinal Cancer, should the article be accepted by the editor-in-chief upon completion of the refereeing process.

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Das, A., Surendran, S., Mathew, M. et al. Patterns of Recurrence in Locally Advanced Resectable Oesophageal Carcinoma: Retrospective Review from a Tertiary Cancer Centre in South India. J Gastrointest Canc 52, 711–718 (2021). https://doi.org/10.1007/s12029-020-00464-2

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  • DOI: https://doi.org/10.1007/s12029-020-00464-2

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