Stereotactic body radiotherapy for oligo-recurrence in the liver in a patient with esophageal carcinoma: A case report

Stereotactic Body Radiation Therapy for Oligometastatic Recurrent Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study From a Single Tertiary Center

BACKGROUND

Oligometastatic disease, characterized by a limited number of metastatic lesions, has gained significant attention for its potential to enable long-term survival with definitive local therapies. Esophageal cancer, an aggressive malignancy often diagnosed at advanced stages, carries a poor prognosis, particularly in cases involving distant metastasis. Stereotactic body radiation therapy (SBRT) has emerged as a promising local treatment modality for oligometastatic disease, offering precise high-dose radiation delivery. This study evaluated the outcomes of SBRT in patients with oligometastatic esophageal cancer.

METHODS

This retrospective study analyzed 33 patients with esophageal cancer who underwent SBRT for all oligometastatic lesions at a single institution between August 2014 and March 2024. The inclusion criteria were patients with squamous cell carcinoma, extracranial oligometastases, and no concurrent systemic therapy. Oligometastatic diseases were categorized into de novo, repeat, and induced subtypes. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were assessed using the Kaplan-Meier method.

RESULTS

The study cohort included 33 patients with a median age of 68 years. Most patients had one treated lesion, with SBRT doses ranging from 25-50 Gy in 4-10 fractions. Median OS and PFS were 17.3 months and 4.2 months, respectively. Patients with locoregional recurrence exhibited longer median PFS (5.1 months) and OS (19.6 months) compared to those with distant metastases (PFS: 3.0 months; OS: 14.8 months). Stratification by oligometastatic subtype revealed the best outcomes in de novo cases, with a median OS of 19.6 months and PFS of 8.8 months. Local control at 1 year was 90.7% for the entire cohort, with limited severe late adverse events.

CONCLUSION

SBRT demonstrated promising outcomes in patients with oligometastatic esophageal cancer, offering high local control with minimal toxicity. Although these results highlight the feasibility of SBRT, larger prospective studies are needed to validate these findings.

Image-guided interstitial high-dose-rate brachytherapy in the treatment of metastatic esophageal squamous cell carcinoma

Purpose

To evaluate the efficacy of computed tomography (CT)- and magnetic resonance imaging (MRI)-guided interstitial high-dose-rate brachytherapy (HDR IBT = IBT) in patients with metastatic esophageal squamous cell carcinoma.

Material and methods

Eleven patients with 21 unresectable metastases of histologically proven esophageal squamous cell carcinoma were included in this retrospective study. Fourteen visceral and 7 lung metastases were treated with image-guided (CT or open MRI guidance) IBT using a ¹⁹²Iridium source (single fraction irradiation). Clinical and imaging follow-up were performed every 3 months after treatment. Primary endpoint was local tumor control (LTC) and safety. Furthermore, we analyzed safety, progression-free survival (PFS), and overall survival (OS).

Results

The median diameter of the target lesions was 2.2 cm (range: 0.7-6.8 cm), treated with a median D₁₀₀ of 20.1 Gy (range: 10-25 Gy). During a median follow-up of 6.3 months (range: 3-21.8 months), three patients displayed local recurrences, resulting in LTC of 85.7%. Median PFS was 3.4 months and median OS after IBT was 13.7 months. No severe adverse events (grade 3+) requiring hospitalization or invasive intervention were recorded.

Conclusions

Image-guided IBT is a safe and effective treatment in patients with metastasized esophageal squamous cell carcinoma.