Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer.

The aim of this retrospective study was to determine the patterns of recurrence and overall survival (OS) in patients achieving clinical complete response after treatment with definitive chemoradiation (CRT) for proximal esophageal cancer. Patients with proximal esophageal cancer treated with CRT between 2004 and 2014 in 11 centers in the Netherlands were included. OS and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Cumulative incidence of first recurrence (locoregional or distant) and locoregional recurrence (LRR) were assessed using competing risk analyses. In 197 of the 200 identified patients, response was evaluated, 133 (68%) showed a complete response. In complete responders, median OS, three-year OS, and PFS were 45.0 months (95% CI 34.8–61.5 months), 58% (95% CI 48–66), and 49% (95% CI 40–57), respectively. Three- and five-year risk of recurrence were respectively 40% (95% CI 31–48), and 45% (95% CI 36–54). Three- and five-year risk of LRR were 26% (95% CI 19–33), and 30% (95% CI 22–38). Eight of 32 patients with an isolated LRR underwent salvage surgery, with a median OS of 32.0 months (95% CI 6.8-not reached). In patients with a complete response after definitive CRT for proximal esophageal cancer, most recurrences were locoregional and developed within the first three years after CRT. These findings suggest to shorten locoregional follow-up from five to three years. • Five-year risk of recurrence after CRT for proximal esophageal cancer was 45%. • Most recurrences were locoregional and mainly in the primary involved tumor field. • Surgery or radiotherapy was performed in 75% of patients with a local recurrence. • Salvage surgery of isolated locoregional recurrence resulted in favorable outcome. • The recurrence pattern suggests that follow-up may be shortened to three years. [ABSTRACT FROM AUTHOR]