Treatment patterns and overall survival for recurrent esophageal or gastroesophageal junctional cancer: A nationwide European population-based study.
Authors: Pape Marieke , Vissers Pauline A.J. , Beerepoot Laurens , Van Berge Henegouwen Mark I. , Lagarde Sjoerd , Mook Stella , Bertwistle David , McDonald Laura , Van Laarhoven Hanneke W.M. , Verhoeven Rob 
Published: January 2021

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Background: Esophageal cancer has a high risk for recurrence after treatment with curative intent. This study describes the characteristics of patients with esophageal or gastroesophageal junctional cancer at the time of recurrence, treatment patterns and overall survival (OS) after recurrence. Methods: Patients selected from the nationwide Netherlands cancer registry had received a primary diagnosis of non-metastatic squamous cell carcinoma or adenocarcinoma of esophagus or gastroesophageal junction in 2015 or 2016 and experienced recurrence after primary treatment with curative intent. Curative intent was defined as receiving resection (with or without [neo]adjuvant therapy) or definitive chemoradiotherapy (dCRT) without surgery. Recurrence within or after six months was calculated from resection date or end of dCRT. OS was calculated from recurrence and analysed using Kaplan-Meier curves with Log-Rank test. Results: We identified 856 patients who presented with disease recurrence after potentially curative treatment with resection (75%) or dCRT (25%). At recurrence, the majority of patients were male (78%),the median age was 68 years and 77% of patients had adenocarcinoma. Twenty-six percent of patients had disease recurrence within six months after curative treatment. Eighteen percent of patients had locoregional recurrence only, 48% distant recurrence only and 33% both locoregional and distant recurrence. Among patients with a distant recurrence, 37% had metastases in non-regional lymph nodes, 31% in the liver and 30% in the lung. After disease recurrence, 29% of patients received systemic therapy (chemo- or targeted therapy), 5% chemoradiotherapy, 1% surgery and 66% best supportive care only. The most common systemic treatment regimen was CapOx/FOLFOX (54%) and13% of patients received a targeted agent: trastuzumab containing regimen (n = 26) or paclitaxel and ramucirumab (n = 5). Among all patients, the median OS from date of recurrence was 4.4 months. Patients with recurrence within six months had a poorer median survival (2.1 months) compared to patients with recurrence after six months (5.7 months; p < 0.001). Median OS in patients with locoregional recurrence only was 7.4 months, distant recurrence only was 4.0 months, and both locoregional and distant recurrence was 3.4 months (p < 0.001). Patients with prior primary treatment with resection had median OS of 4.2 months and patients with prior dCRT of 5.1 months (p = 0.605). Conclusions: The majority of patients had distant metastases at disease recurrence and a small proportion received systemic therapy after recurrence. Overall prognosis was poor, and survival outcomes were poorest among patients with recurrence within six months of initial curative treatment suggesting a worse biological tumor behaviour.