Clinical Analysis of Salvage Radiotherapy for Local Recurrent Esophageal Carcinoma

Objective To analyze the long-term efficacy and toxicity of salvage radiotherapy for local recurrent esophageal carcinoma. Methods One hundred and sixteen patients with local recurrent esophageal carcinoma underwent salvage radiotherapy. Radiotherapy technology was conventional twodimensional planning(15%) and conformal three-dimensional planning(85%). Sixty-six patients were treated with concurrent chemoradiotherapy. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy. Results Median follow-up time for surviving patients from the start of R(C)T was 38 months (range 10-105 months). Relief of symptoms was 76%. The median survival time was 14 months and the median recurrence-free interval was 8 months. The survival rates at 1, 2, and 3 years were 56.9%，29.3% and 14.7%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 43.1%, 20.6% and 10.4%, respectively. Nine patients lived more than 5 years(range 61-105 months). The median survival time and the survival rates at 3 years were 9 months and 5% in salvage radiotherapy dose??45 Gy group, while 19 months and 24% in those who received dose≥45 Gy（P=0.001）. The median survival time and the survival rates at 3 years was 4 months and 10% in patients who used conventional two-dimensional planning, while 15 months and 19% in those who used conformal three-dimensional planning (P=0.03). Radiation esophagitis and radiodermatitis at grade 2 and 3 were most common acute toxicities. No treatment-related death was observed. Conclusion Salvage radio(chemo)therapy is effective for local recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of local recurrent esophageal carcinoma is poor, however, longer survival after radio(chemo)therapy might be possible, even could reach long-term survival. A salvage radiation dose≥45Gy and conformal RT are associated with a better prognosis.