Surgically treated esophageal cancer developed in a radiated field: Impact on peri-operative and long-term outcomes

Abstract

Background: The objectives of this study were to compare peri‐operative and long‐term outcomes from esophageal cancer (EC) (i) that arose in a previously radiated field (ECRF) versus primary (PEC) and among ECRF patients (ii) radiotherapy‐induced (RIEC) versus non radiotherapy‐induced EC (NRIEC). Methods: Data was collected from 30 European centers from 2000‐2010. 2489 EC patients surgically treated were included in the PEC group and 136 in the ECRF group, including 61 in the NRIEC group and 75 in the RIEC group. Propensity score matching analyses were used to compensate for differences in baseline characteristics. Results: Compared to the PEC group, the ECRF group was characterized by less use of neoadjuvant chemoradiotherapy (0% vs. 29.5%; P < 0.001), less pathological stage III/ IV (31.6% vs 39.2%, P = 0.036), greater incidence of R1/2 margins (21.3% vs. 10.9%; P < 0.001), increased in‐hospital mortality (14.0% vs. 7.1%; P = 0.003) and overall morbidity (68.4% vs. 56.4%, P = 0.006). After matching, 5‐year overall (28.8% vs. 50.5%; HR = 1.53, 95% C.I. 1.15‐2.04; P = 0.003) and event‐free (32.2% vs. 42.5%; HR = 1.56, 95% C.I. 1.18‐2.05; P = 0.002) survivals were significantly reduced in the ECRF group. There were no significant differences in incidence or pattern of tumor recurrence. Comparing RIEC and NRIEC groups, there were no significant differences in short‐ or long‐term outcomes before and after matching. Conclusions: ECRF is associated with poorer long‐term survival related to a reduced utilization of neoadjuvant chemoradiotherapy and an increased incidence of tumor margin involvement at surgery. Outcomes are dictated by the limitations related to previous radiotherapy administration more than the radiotherapy‐induced carcinogenesis.