Radiotherapy for anastomotic recurrence after radical resection of esophageal carcinoma.

Objective To assess the role of radiotherapy for anastomotic recurrence after radical resection of esophageal carcinoma. Methods From 1958 to December 1996, 61 patients who had negative margin but later developed anastomotic recurrence after resection of esophageal carcinoma were reviewed. All patients received surgery as a primary treatment. The duration from operation to recurrence was 3～161 months with a median of 16 months. Twenty-seven patients had anastomotic recurrence only and the remaining 34 patients had both anastomotic recurrence and mediastinal lymph node metastasis. Forty-six patients were treated with radiotherapy, and 15 patients with chemotherapy (10 patients) or simple observation (5 patients). Results The overall survivals at 1-, 3- and 5-year were 88.5%, 31.2%, and 19.7%, respectively. The corresponding post-recurrence survivals were 26.3%, 3.3%, and 1.6%, respectively. For patients relapsed within one year, the overall survival and post-recurrence survival at 5 years were 0.0% and 0.0% whereas for those relapsed more than one year after operation, the corresponding survivals were 31.4% and 8.9%, respectively. The difference was statistically significant. The overall 5-year survival was 33.3% for patients with anastomotic recurrence only and 5.9% for patients with both anastomotic recurrence and mediastinal lymph node metastasis (P=0.07). Patients treated with radiotherapy had a better prognosis than those treated with chemotherapy or observation. The overall 5-year survival was 28.3% for radiotherapy and 0.0% for observation, respectively (P0.01). The 1-year post-recurrence survival was 28.3% for radiotherapy and 0.0% for observation or chemotherapy. Conclusions The duration from operation to anastomotic recurrence is an important prognostic factor. Radiotherapy for anastomotic recurrence is able to improve the local control rates and survivals.