P24 TREATMENT FOR RECURRENT ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER CURATIVE ESOPHAGECTOMY

Aim The aim is to find out what treatment should be chosen at the time of recurrence of the esophageal squamous cell carcinoma (ESCC) after curative esophagectomy. Background & Methods ESCC patients with recurrence after curative resection have extremely poor survival rates. However, long-term survival cases and complete cure cases have also been reported. We retrospectively evaluated 184 patients with recurrent ESCC after curative esophagectomy between 2001 and 2015. Results M/F: 148/36, Median age: 64(36-84), Location: Upper third/Middle/Lower: 18/105/61, Pretreatment: None/Neoadjuvant chemotherapy/Neoadjuvant chemoradiotherapy (CRT)/Definitive CRT: 79/42/30/33, pT0/1/2/3/4: 3/39/18/119/5, pN0/1/2/3: 51/59/51/22, pStage1/2/3/4: 24/51/95/14 (UICC 7th), Recurrence site: Lymph node 124 (67%) [cervical 35 (19%), mediastinum 82 (45%), abdomen 35 (19%)], lung 36 (20%), liver 32 (17%), pleura 18 (10%), bone 13 (7%), brain 3 (1.6%), peritoneum 3, skin 2 (1.1%) adrenal 2, residual esophagus 1 (0.5%), gastric tube 1, colon 1, kidney 1, testis 1. First treatment after recurrence: Surgery/CRT/chemotherapy/Best Supportive Care (BSC): 8/89/64/23. Regarding to overall survival after recurrence by the treatment groups, there was a significant difference between all groups; surgery (median 61 months) > CRT (17) > chemotherapy (9) > BSC (1). Surgery was performed to the patients with solitary lesion (lung 3, cervical lymph node 3, descending colon 1, brain 1). Prognosis of the patients with single-organ recurrence was better than that of those with multi-organ recurrence only in CRT group, and prognosis of the patients without pretreatment was better than that of those with pretreatment only in chemotherapy group. Regarding to the time from esophagectomy to recurrence, the patients with the duration of 6 months or more had a good prognosis compared with those with less than 6 months only in CRT group. Conclusion As treatment for recurrent ESCC after curative esophagectomy, some treatment may be recommended as much as possible. Priority is given in the order of Surgery > CRT > Chemotherapy. Surgery may be recommended for the patients with solitary recurrence of lung or cervical Lymph nodes. CRT may be recommended for the patients with single-organ recurrence, at least six months after esophagectomy. Chemotherapy may be recommended for the patients without preoperative treatment.