Finally, chemoradiation itself may alter patterns of recurrence in esophageal cancer, Dr. Schmidt said. Findings previously reported by the VUMC group showed "some strange patterns of recurrence that specifically included some of our patients who had a complete response, including first recurrences in bone, brain, and soft-tissue locations that seemed unusual first-recurrence sites for this disease; 78% of our recurrences were distal, not locoregional," he said. "We think perhaps that chemoradiation therapy changes the biology of the disease and patterns of recurrence. This may explain some of the survival results seen in our studies and others. This is something that we should look at further."