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Objective:To compare the efficacy and adverse events of salvage radiotherapy and other treatments for recurrent esophageal cancer after chemoradiotherapy in this Meta-analysis.Methods:Databases including PubMed, Embase, Cochrane Library, CNKI and Wanfang data were searched from the inception to April 2020 to collect the clinical trials which comparatively analyzed the efficacy and safety between radiotherapy and other treatments for recurrent esophageal cancer after chemoradiotherapy. Meta-analysis was performed using RevMan 5.1 software. RR and 95% CI were used to describe the differences among different groups. Results:According to the inclusion and exclusion criteria, a total of 11 clinical trials involving 842 patients were included. Meta-analysis showed that the overall survival in the salvage radiotherapy group was significantly lower than that in the salvage esophagectomy group ( RR=0.40, 95% CI: 0.27-0.61, P<0.001), whereas significantly higher than that in the chemotherapy group ( RR=2.91, 95% CI: 1.43-5.95, P=0.003). There was no significant difference in the treatment-related mortality between the salvage radiotherapy and salvage esophagectomy groups ( RR=0.53, 95% CI: 0.14-1.98, P=0.350), but the incidence was significantly higher in the salvage esophagectomy group (1.7%-11.4% vs. 1.9%-2.8%). Conclusion:Salvage radiotherapy is an effective treatment for recurrent esophageal cancer after chemoradiotherapy, which can be regarded as one choice for clinical patients.
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Objective To evaluate the efficacy of rescue treatment for recurrent esophageal cancer after radical esophagectomy, and to provide insights into the development of comprehensive treatment for esophageal cancer.Methods The clinical data of 218 patients who were confirmed with recurrent metastatic esophageal cancer after R0 resection and received rescue treatment in our hospital from 2004 to 2014 were retrospectively reviewed.The survival rate was determined by the Kaplan-Meier method.Univariate and multivariate prognostic analyses were performed using the log-rank test and Cox proportional hazards model, respectively.Results The median post-recurrence follow-up time was 53 months.The 1-and 3-year overall survival (OS) rates after recurrence were 57.2% and 24.4%, respectively.Among the 163 patients with local recurrence, the 1-and 3-year OS rates were 70% and 42% for patients treated with chemoradiotherapy (n=40), 55% and 24% for those with radiotherapy alone (n=106), and 23% and 8% for those with supportive therapy (n=13)(chemoradiotherapy vs.radiotherapy alone P=0.045, radiotherapy alone vs.supportive therapy P=0.004;none of the patients who were treated with chemotherapy alone survived for one year or more).Univariate analysis showed that N staging, TNM staging, and post-recurrence rescue treatment regimen were independent prognostic factors for esophageal cancer (all P=0.001).On the other hand, multivariate analysis indicated that only rescue treatment regimen was the independent prognostic factor for esophageal cancer (P=0.013).Conclusions Rescue chemoradiotherapy or radiotherapy alone can bring significant survival benefits for patients with recurrent and metastatic, especially locally recurrent, esophageal cancer following radical esophagectomy.