Post-operative radiation therapy for esophageal cancer: analysis of failure pattern

This study evaluated the survival, local control, prognostic factor, and failure pattern of patients with esophageal cancer treated with operation and adjuvant radiation therapy to use as fundermental data of postoperative radiation therapy. A retrospective analysis was undertaken of 82 patients who had locally advanced esophageal cancer treated with operation and adjuvant radiation therapy from January 1988 to December 1995. According to AJCC staging, stage IIA were in 26 patients, stage IIB in 4 patients, and stage III in 52 patients. Squamous cell carcinoma were in 77 patients, adenosquamous carcinoma in 3 patients, and adenocarcinoma in 2 patients. The patients received radiation therapy ranging from 41.0Gy to 64.8 Gy. Five patients received neoadjuvant chemotherapy. Two-year survival and local control rates for all patients wer 36.8% and 30.4% respectively. And they were 9.3% and 26.3% respectively at 5 years. According to stages, 2-year survival rates were 50.2% in IIA, 0% in IIB and 23.3% in III (p=0.004). Two-year local control rates were 49.2% in IIA, 66.6% in IIB and 24.7% in III (p=0.01). Sixty patients developed recurrence, which were 3 tumor margin, 23 lymph node recurrence, 4 tumor margin and lymph node, 1 tumor margin and distant metastasis, 9 lymph node and distant metastasis, 17 distant metastasis and 3 unknown metastatic sity. Prognostic factors affecting survival were smoking (p=0.02), Tstaging (p=0.0092), N-staging (p=0.0045). Prognostic factors affecting local control were T-staging (p=0.019), N-staging (p=0.047). In spite of post-operative radiation therapy, predominant failure pattern was local failure. Especially regional lymph node failure was major cause of local failure. So strategy of aggresive adjuvant radiation therapy to regional lymph node area in post operative treatment should be proposed