Patterns of care for relapsed oesophageal cancer after initial curative trimodality therapy: long-term follow-up of the SAKK 75/08 trial
Menée à partir de données portant sur 103 patients atteints d'un cancer de l'oesophage récidivant et inclus dans un essai randomisé de phase 3 (durée médiane de suivi : 5,8 ans), cette étude analyse la survie en fonction du traitement indiqué et du type de récidive de la maladie chez les patients initialement traités par thérapie trimodale (chimiothérapie d'induction, radiochimiothérapie et chirurgie avec ou sans cétuximab)
Background: Recurrent oesophageal cancer after initial curative multimodality treatment is a disease condition with a poor prognosis. There is limited evidence on recurrence patterns and on the optimal therapeutic approach. Methods: We analysed the pattern of disease recurrence and subsequent therapies in patients with recurrent oesophageal cancer based on prospectively collected data within a predefined subproject of the randomized phase 3 trial SAKK 75/08. Results: Among 300 patients included in the SAKK 75/08 trial, tumor recurrence was observed in 103 patients with a median follow-up of 5.8 years. Locoregional recurrence only was found in 26.2% of the patients, 21.4% had both distant and locoregional recurrence and 52.4% had distant recurrence only. Fifty-nine patients (58%) received at least one line of systemic therapy at recurrence, most commonly oxaliplatin-based combination therapies for adenocarcinoma and single-agent chemotherapy for squamous cell carcinoma. Local therapies, most commonly palliative radiotherapy, were used in 49 patients (48%). Six patients underwent a second curative resection or radiochemotherapy. We found no significant overall survival (OS) difference for isolated locoregional recurrence versus distant recurrence (15.1 vs. 8.7 months, p= 0.167). In a multivariable Cox regression model, time from esophagectomy to recurrence and the number of recurrence sites as well as the use of systemic therapy or a second curative local therapy significantly correlated with OS. Conclusions: Recurrent oesophageal cancer remains a disease with a poor prognosis and requires multidisciplinary management. A second curative approach for localized disease recurrence may be an option for highly selected patients.