Outcomes of Radiation-Associated Esophageal Squamous Cell Carcinoma: The MSKCC Experience

ObjectiveEsophageal squamous cell carcinoma (ESCC-R) is a rarely encountered sequela of chest radiation. Treatment is limited by toxicity with reirradiation and complex surgical dissection in a previously radiated field. The clinical presentation, prognosis, and treatment selection of ESCC-R remain undefined.MethodsA retrospective review of patients with esophageal squamous cell carcinoma at a single institution between 2000 and 2017 was performed to identify patients with previous radiation therapy (5years delay). Clinicopathologic characteristics, treatment, and outcomes of ESCC-R (n=69) patients were compared to patients with primary esophageal squamous cell carcinoma (ESCC) (n=827). Overall survival (OS) and cumulative incidence of recurrence (CIR) were compared using log-rank and Gray's tests, respectively.ResultsMedian time from radiation to ESCC-R was 18.2years. The majority of ESCC-R patients werefemale and presented with earlier disease and decreased behavioral risk factors. ESCC-R treated with surgery alone had worse OS than ESCC (5-year 15 vs 33%; p=0.045). Patients with ESCC-R who received neoadjuvant treatment had higher risk of postoperative in-house mortality (16.7 vs 4.2%; p=0.032). Patients with ESCC-R treated with surgery alone and definitive chemoradiation had higher recurrence risk than those with neoadjuvant+surgery (5-year recurrence 55 and 45 vs 15%; p=0.101).ConclusionNeoadjuvant chemotherapy or chemoradiation should be used whenever possible for ESCC-R as it is associated with lower risk of recurrence. The improved survival benefits of aggressive treatment must be weighed against the higher associated postoperative risks.