Skip Navigation LinksHome > December 2013 - Volume 8 - Issue 12 > Esophageal Cancer Recurrence Patterns and Implications for S...
Journal of Thoracic Oncology:
doi: 10.1097/01.JTO.0000437420.38972.fb
Original Articles

Esophageal Cancer Recurrence Patterns and Implications for Surveillance

Lou, Feiran MD, MS; Sima, Camelia S. MD, MS; Adusumilli, Prasad S. MD; Bains, Manjit S. MD; Sarkaria, Inderpal S. MD; Rusch, Valerie W. MD; Rizk, Nabil P. MD, MS

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Abstract

Introduction:

After definitive treatment of esophageal cancer, patients are at high risk for recurrence. Consistent follow-up is important for detection and treatment of recurrence. The optimal surveillance regimen remains undefined. We investigated posttreatment recurrence patterns and methods of detection in survivors of esophageal cancer.

Methods:

We retrospectively studied a cohort of patients who had undergone surgical resection for esophageal cancer at our institution between 1996 and 2010. Routine computed tomography scan and upper endoscopy were performed for surveillance.

Results:

In total, 1147 patients with resected esophageal adenocarcinoma or squamous cell carcinoma were included (median follow-up, 46 months). Of these, 723 patients (63%) had received neoadjuvant therapy before surgery. During follow-up, there were 595 deaths (52%) and 435 recurrences (38%) (distant [55%], locoregional [28%], or both [17%]). Half of recurrences were detected as a result of symptoms (n = 217), 45% by routine chest and abdominal computed tomography scan (n = 194), and 1% by surveillance upper endoscopy (n = 6). The recurrence rate decreased from 27 per 100 person-years in posttreatment year 1 to 4 per 100 person-years in year 6. In the first 2 years, the rate of recurrence was higher among patients who had received neoadjuvant therapy (35 per 100 person-years) than among those who had not (14 per 100 person-years) (p < 0.001).

Conclusions:

The incidence of recurrence is high after esophagectomy for cancer. Surveillance endoscopy has limited value for detection of asymptomatic local recurrence. The yield from follow-up scans diminishes significantly after the sixth year; surveillance scans after that point are likely unnecessary.

Copyright © 2013 by the International Association for the Study of Lung Cancer

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