Patterns of care for relapsed oesophageal cancer after initial curative trimodality therapy: Long-term follow-up of the SAKK 75/08 trial. (December 2022)

• Record Type: Journal Article
• Authors: Panje, Cédric; Hayoz, Stefanie; Eisterer, Wolfgang; Hess, Viviane; Thuss-Patience, Peter; Schacher, Sabina; Dürr, Donat; Wagner, Anna Dorothea; Girschikofsky, Michael; Eboulet, Eric; Stahl, Michael; Ruhstaller, Thomas
• Is Part Of: European journal of cancer. Volume 177(2022)
• Page Start: 186
• Page End: 193
• Publication Date: 2022-12
• Subjects: Oesophageal cancer -- Recurrence -- Trimodality -- Chemotherapy -- Radiotherapy; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.09.035
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Recurrent oesophageal cancer after the initial curative multimodality treatment is a disease condition with a poor prognosis. There is limited evidence on recurrence patterns and on the optimal therapeutic approach. Methods: We analysed the pattern of disease recurrence and subsequent therapies in patients with recurrent oesophageal cancer based on prospectively collected data within a predefined subproject of the randomised phase 3 trial Swiss Group for Clinical Cancer Research (SAKK) 75/08. Results: Among 300 patients included in the SAKK 75/08 trial, tumour recurrence was observed in 103 patients with a median follow-up of 5.8 years. Locoregional recurrence only was found in 26.2% of the patients, 21.4% of patients had both distant and locoregional recurrence and 52.4% of patients had distant recurrence only. Fifty-nine patients (58%) received at least one line of systemic therapy at recurrence, most commonly oxaliplatin-based combination therapies for adenocarcinoma and single-agent chemotherapy for squamous cell carcinoma. Local therapies, most commonly palliative radiotherapy, were used in 49 patients (48%). Six patients underwent a second curative resection or radiochemotherapy. We found no significant overall survival difference for isolated locoregional recurrence versus distant recurrence (15.1 versus 8.7 months, p = 0.167). In a multivariable Cox regression model, time from oesophagectomy to recurrence and the number of recurrence sites as well as the use of systemic therapy or a second curative local therapy significantly correlated with overall survival. Conclusions: Recurrent oesophageal cancer remains a disease with a poor prognosis and requires multidisciplinary management. A second curative approach for localised disease recurrence may be an option for highly selected patients. Highlights: Tumour recurrence is common after trimodality therapy for oesophageal cancer. The most common pattern is distant recurrence with or without local recurrence. In 58% of patients, various systemic therapies were initiated depending on histology. Time to recurrence, recurrence sites and systemic therapy correlated with survival.