Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 11–22 | Cite as

Outcomes of Radiation-Associated Esophageal Squamous Cell Carcinoma: The MSKCC Experience

  • Tamar B. Nobel
  • Arianna Barbetta
  • Meier Hsu
  • Kay See Tan
  • Tiffany Pinchinat
  • Francisco Schlottmann
  • Manjit S. Bains
  • Geoffrey Y. Ku
  • Abraham J. Wu
  • Marco G. Patti
  • David R. Jones
  • Daniela MolenaEmail author
2018 SSAT Plenary Presentation



Esophageal squamous cell carcinoma (ESCC-R) is a rarely encountered sequela of chest radiation. Treatment is limited by toxicity with reirradiation and complex surgical dissection in a previously radiated field. The clinical presentation, prognosis, and treatment selection of ESCC-R remain undefined.


A retrospective review of patients with esophageal squamous cell carcinoma at a single institution between 2000 and 2017 was performed to identify patients with previous radiation therapy (≥ 5 years delay). Clinicopathologic characteristics, treatment, and outcomes of ESCC-R (n = 69) patients were compared to patients with primary esophageal squamous cell carcinoma (ESCC) (n = 827). Overall survival (OS) and cumulative incidence of recurrence (CIR) were compared using log-rank and Gray’s tests, respectively.


Median time from radiation to ESCC-R was 18.2 years. The majority of ESCC-R patients were female and presented with earlier disease and decreased behavioral risk factors. ESCC-R treated with surgery alone had worse OS than ESCC (5-year 15 vs 33%; p = 0.045). Patients with ESCC-R who received neoadjuvant treatment had higher risk of postoperative in-house mortality (16.7 vs 4.2%; p = 0.032). Patients with ESCC-R treated with surgery alone and definitive chemoradiation had higher recurrence risk than those with neoadjuvant + surgery (5-year recurrence 55 and 45 vs 15%; p = 0.101).


Neoadjuvant chemotherapy or chemoradiation should be used whenever possible for ESCC-R as it is associated with lower risk of recurrence. The improved survival benefits of aggressive treatment must be weighed against the higher associated postoperative risks.


Esophageal squamous cell carcinoma Reirradiation Treatment selection Neoadjuvant therapy 



The authors would like to thank Furio Nick Savone, lymphoma and esophageal cancer survivor, for inspiring the design and development of this study.

Funding Sources

This study was supported, in part, by the National Institutes of Health/National Cancer Institute Cancer Support Grant P30 CA008748. Tamar Nobel is supported, in part, by a grant from the American Cancer Society.

Author Contributions

Tamar Nobel, Arianna Barbetta, David Jones, and Daniela Molena contributed to the conception and design of the work. Tamar Nobel, Arianna Barbetta, Tiffany Pinchinat, Franscisco Schlottman, Manjit Bains, Geoffrey Ku, Abraham Wu, and Marco G. Patti contributed to the acquisition and interpretation of data. Meier Hsu and Kay See Tan contributed to the analysis and interpretation of data. Tamar Nobel, Meier Hsu, Kay See Tan, and Daniela Molena wrote the manuscript with critical revision from all other authors. All authors are in agreement to be accountable for ensuring the accuracy and integrity of the work.

Supplementary material

11605_2018_3958_MOESM1_ESM.docx (219 kb)
ESM 1 (DOCX 218 kb)
11605_2018_3958_MOESM2_ESM.docx (218 kb)
ESM 2 (DOCX 218 kb)


  1. 1.
    Miller KD, Siegel RL, Chieh Lin C, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66:271–289.CrossRefGoogle Scholar
  2. 2.
    Bryant AK, Banegas MP, Martinez ME, Mell LK, Murphy JD. Trends in radiation therapy among cancer survivors in the United States, 2000-2030. Cancer Epidemiol Biomarkers Prev 2017;26:963–970.CrossRefGoogle Scholar
  3. 3.
    Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA 2003; 290:2831.CrossRefGoogle Scholar
  4. 4.
    Stubblefield MD. Neuromuscular complications of radiation therapy. Muscle Nerve 2017;56:1031–1040.Google Scholar
  5. 5.
    Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med 2017;38:201–208.CrossRefGoogle Scholar
  6. 6.
    Zablotska LB, Chak A, Das A, Neugut AI. Increased risk of squamous cell esophageal cancer after adjuvant radiation therapy for primary breast cancer. Am J Epidemiol 2005;161:330–337.CrossRefGoogle Scholar
  7. 7.
    Morton LM, Gilbert ES, Stovall M, et al. Risk of esophageal cancer following radiotherapy for Hodgkin lymphoma. Haematologica. 2014;99:e193-e196.CrossRefGoogle Scholar
  8. 8.
    Grantzau T, Overgaard J. Risk of second non-breast cancer after radiotherapy for breast cancer: a systematic review and meta-analysis of 762,468 patients. Radiother Oncol 2015;114:56–65.CrossRefGoogle Scholar
  9. 9.
    Morton LM, Gilbert ES, Hall P, et al. Risk of treatment-related esophageal cancer among breast cancer survivors. Ann Oncol Off J Eur Soc Med Oncol 2012;23:3081–3091.CrossRefGoogle Scholar
  10. 10.
    Ahsan H, Neugut AI. Radiation therapy for breast cancer and increased risk for esophageal carcinoma. Ann Intern Med 1998;128:114.CrossRefGoogle Scholar
  11. 11.
    Markar SR, Gronnier C, Pasquer A, et al. Surgically treated oesophageal cancer developed in a radiated field: impact on peri-operative and long-term outcomes. Eur J Cancer 2017;75:179–189.CrossRefGoogle Scholar
  12. 12.
    Farjah F, Gerdes H, Glasgow RE, et al. Debbie’s dream foundation: curing stomach cancer NCCN guidelines version 1.2018 panel members esophageal and esophagogastric junction cancers. Accessed May 10, 2018.
  13. 13.
    Scholl B, Reis ED, Zouhair A, Chereshnev I, Givel JC, Gillet M. Esophageal cancer as second primary tumor after breast cancer radiotherapy. Am J Surg 2001;182:476–480.CrossRefGoogle Scholar
  14. 14.
    Matheson JB, Burmeister BH, Smithers BM, Gotley D, Harvey JA, Doyle L. Second primary oesophageal cancer following radiation for breast cancer. Radiother Oncol 2002;65:159–163.CrossRefGoogle Scholar
  15. 15.
    Berrington de Gonzalez A, Gilbert E, Curtis R, et al. Second solid cancers after radiation therapy: a systematic review of the epidemiologic studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys 2013;86:224–233.CrossRefGoogle Scholar
  16. 16.
    Schena M, Battaglia AF, Munoz F. Esophageal cancer developed in a radiated field: can we reduce the risk of a poor prognosis cancer? J Thorac Dis 2017;9:1767–1771.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Tamar B. Nobel
    • 1
    • 2
    return OK on get
  • Arianna Barbetta
    • 1
  • Meier Hsu
    • 3
  • Kay See Tan
    • 3
  • Tiffany Pinchinat
    • 4
  • Francisco Schlottmann
    • 5
  • Manjit S. Bains
    • 1
  • Geoffrey Y. Ku
    • 6
  • Abraham J. Wu
    • 6
  • Marco G. Patti
    • 5
  • David R. Jones
    • 1
  • Daniela Molena
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryMount Sinai HospitalNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of SurgeryBrookdale University HospitalBrooklynUSA
  5. 5.Department of Medicine and SurgeryUniversity of North CarolinaChapel HillUSA
  6. 6.Department of OncologyMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations