A consensus treatment strategy for
esophageal squamous cell carcinoma (ESCC) patients who recur after definitive
radiochemotherapy/
radiotherapy has not been established. This study compared the outcomes in ESCC patients who underwent salvage surgery, salvage chemoradiation (CRT) or best supportive care (BSC) for local recurrence. Ninety-five patients with clinical stage I to III ESCC who had completely responded to the initial definitive
radiochemotherapy or
radiotherapy alone and developed local recurrence were enrolled in this study. Fifty-one of them received salvage
esophagectomy, and R0 resection was performed in 41 patients, 36 underwent salvage CRT, and the remaining eight patients received BSC only. The 5-year overall survival was 4.6% for the 87 patients receiving salvage surgery or CRT, while all patients in the BSC group died within 12.0 months, the difference was statistically significant (P = 0.018). The 1-, 3-, 5-year survival rates in the salvage surgery and salvage CRT groups were 45.1%, 20.0%, 6.9% and 51.7%, 12.2%, 3.1%, respectively, there was no difference of overall survival between the two groups (P = 0.697). Patients also presented with lymph node relapse had inferior survival compared to those with isolated local
tumor recurrence after
salvage therapy. In the salvage surgery group,
infections occurred in eight patients, and three developed
anastomotic leakage. In the salvage CRT group, grade 2-4
esophagitis and
radiation pneumonitis was observed in 19 and 3 patients, respectively. Seven patients (19.4%) developed
esophagotracheal fistula or
esophageal perforation. This study of salvage CRT versus salvage surgery for recurrent ESCC after definitive
radiochemotherapy or
radiotherapy alone did not demonstrate a statistically significant survival difference, but the frequency of complications including
esophagotracheal fistula and
esophageal perforation following salvage CRT was high.