Radiotherapy for nodal recurrence after chemoradiotherapy for esophageal carcinoma

Background To evaluate the treatment outcome of radiotherapy for nodal recurrence after definitive chemoradiotherapy for esophageal carcinoma.Methods Between 1996 and 2001, ten patients with isolated nodal recurrence after definitive chemoradiotherapy received radiotherapy with or without chemotherapy. The site of recurrence was the mediastinum in five patients, the celiac node in four patients, and the supraclavicular fossa in one patient. All sites of nodal recurrence were outside the previous irradiated area and without local recurrence or distant metastases. Radiotherapy was given with three-dimensional conformal technique, and an average total dose was 60Gy. Eight patients received chemotherapy concurrently with radiotherapy. Chemotherapy consisted of two cycles of cisplatin and 5-FU.Results The control rate of the irradiated region was eight of ten patients. The size of all controlled lesions was 3cm or less in diameter. In five patients, distant metastases developed to other organs and caused death. Two patients survived without disease for 5 years and three patients survived 2 years or more. In four patients with an interval of 2 years or longer between the previous treatment and nodal recurrence, three patients survived without disease. Improvement of clinical symptoms such as dysphagia or hoarseness was obtained in five of six patients.Conclusions Radiotherapy for isolated nodal recurrence of esophageal carcinoma after definitive chemoradiotherapy is suggested to be safe and effective. This treatment is promising as well as palliative.