Definitive therapy for isolated esophageal metastases prolongs survival

Local and distant recurrences are frequent after curative resection for esophageal cancer and are considered uniformly fatal. However, some patients may present with isolated recurrences that appear amenable to definitive local therapy either by resection or chemoradiotherapy. We reviewed the clinical outcome of all patients with isolated nodal or distant metastases who were treated with curative intent.

In this retrospective review, all patients (n=561) who underwent curative resection for esophageal cancer from 1988 to 2011 were identified from a prospectively assembled thoracic surgery database. Patients who had any type of recurrence were identified (n=205). In this group, 27 patients were identified with isolated disease defined as single station of nodal disease or isolated distant metastases. Survival was modeled using the Kaplan-Meier method, and subgroup survival estimates were compared by the log rank test. The impact of age, sex, histology, pathology stage, site of recurrence, and treatment modality on mortality were analyzed by logistic regression.

Twenty-seven patients (22 male, median age 61 years) had an isolated esophageal cancer recurrence; of those, 15 patients underwent surgical resection and 12 underwent definitive chemoradiation therapy. The sites of isolated recurrence were most commonly nodal. Median overall survival from time of recurrence was 25.2 months; 3-year estimated survival was 33.0% (confidence interval: 13.7 to 52.5). In univariate analysis, no relationship was formed.

In appropriately selected patients with isolated esophageal metastases, definitive therapy can prolong survival. A long disease-free interval and recurrence limited to single nodal stations may select patients likely to have longer survival after definitive local therapy.