# Re-irradiation for recurrent esophageal cancer: clinical benefit, survival outcomes, and toxicity profile

## TL;DR

Re-irradiation for recurrent esophageal cancer is feasible, well-tolerated, and provides clinical benefits with improved survival.

## Contribution

Demonstrates clinical benefit and survival improvement with low toxicity in reirradiation for recurrent esophageal cancer.

## Key findings

- Palliative reirradiation provided clinical benefit in 72% of patients.
- Median survival was significantly higher in patients with symptom improvement after reirradiation.
- Low acute toxicity was observed, with no grade ≥4 toxicities reported.

## Abstract

•According to our results, reirradiation for recurrent esophageal cancer appeared to be feasible and well tolerated.•Clinical benefit was significantly associated with improved overall survival.•Acute and late toxicity of treatment was low and manageable.

According to our results, reirradiation for recurrent esophageal cancer appeared to be feasible and well tolerated.

Clinical benefit was significantly associated with improved overall survival.

Acute and late toxicity of treatment was low and manageable.

To evaluate survival and toxicity in patients with recurrent esophageal cancer treated with curative (cRT) and palliative (pRT) reirradiation.

From May 2015 to August 2024, 41 patients with locally recurrent esophageal cancer received cRT or pRT. Toxicity was assessed using CTCAE v5.0. Overall survival (OS) was analyzed using the Kaplan-Meier method. Clinical benefit of pRT (reduction in dysphagia, pain or bleeding) was assessed 4 weeks after reRT.

The cohort consisted of 41 patients (median age 73 years). At reirradiation, 36 patients received pRT (20 Gy/5fx or 30 Gy/10fx), and 5 received cRT (50.4 Gy/28fx with chemotherapy). Sixteen patients (39%) had metastatic disease (M1). Median OS was 11.9 months for M0 cRT, 9.8 months for M0 pRT, and 2.8 months for M1 pRT (p = 0.003). The pRT provided clinical benefit in 72% of patients: the median OS for M0 patients who did and did not experience symptoms improvement from reirradiation was 9.8 and 5 months, respectively; M1 patients with and without therapeutic effect had a median OS of 4.5 and 2.2 months, respectively (p < 0.001). Acute toxicity was low, with 5 pRT patients requiring a nasogastric tube and 1 patient developing grade 3 skin toxicity. No grade ≥ 4 toxicities were reported.

Palliative reirradiation in patients with recurrent esophageal cancer showed clinical benefit in 72% of the patients, with impact on OS both in M0 and M1 patients and low rate of acute toxicity. These findings support the use of reirradiation as a feasible and effective strategy in selected patients with recurrent esophageal cancer.