Explore the Radiotherapeutic Clinical Target Volume Delineation for Thoracic Esophageal Squamous Cell Carcinoma from the Pattern of Lymphatic Metastases

Cheng, Jian; Kong, Lingling; Li, Baosheng; Li, Hongsheng; Wang, Zhongtang; Zhang, Jian; Zhou, Tao; Sun, Hao

doi:10.1097/jto.0b013e31827e1f6d

Cited by 34 publications

(44 citation statements)

References 22 publications

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“…Three-field lymphadenectomy was performed when cervical LN metastases were considered by ultrasound examination or computed tomography scan prior to surgery. Tumor-node-metastasis staging system (7th edition) was used to evaluate tumor T and N stages (6).…”

Section: Surgical Procedures and Histopathological Assessmentmentioning

confidence: 99%

“…Besides adjuvant chemotherapy, postoperative irradiation has been a major treatment used to decrease the local recurrence rate in patients with ESCC (2,3). According to the nomination of lymph node (LN) stations by the Japanese Society for Esophageal Disease (JSED) (4), it is accepted that 101, 104, 105 and 106 LN stations should be included in the treatment planning of postoperative irradiation in upper thoracic ESCC, as well as 106, 107, 108, 110, 1, 2, 3 and 7 LN stations for middle thoracic ESCC while 107, 108, 110, 112, 1, 2, 3 and 7 LN stations for lower thoracic ESCC, respectively, which were based on the pattern of LNM in ESCC reported by various researchers (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation

et al. 2018

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Abstract. The aim of the present study was to explore the patter n of lymph node metastasis (LN M) in poorly-differentiated esophageal squamous cell carcinoma (pdESCC) and the implication of postoperative irradiation. A total of 690 patients with pdESCC were retrospectively investigated. The rates of intro-thoracic and extra-thoracic LNM in pdESCC were investigated and compared to previous research on ESCC en bloc. The comparison of the rates between pdESCC and ESCC were performed using the Cochran-Mantel-Haenszel test. The clinicopathological factors associated with LNM in pdESCC were analyzed by Chi-squared tests, and Fisher's exact test was used to assess the rate difference of extra-thoracic LNM. Logistic-regression analysis was used to explore risk factors associated with lymph node (LN) station. Results demonstrated that the distribution pattern of LNM in pdESCC was significantly different compared with that of ESCC (P<0.05). Univariate and multivariate analysis indicated that risk factors associated with LNM were depth and length (P<0.001 and P<0.001) and multivariate analysis also indicated that the location of the tumor (P= 0.042) was a risk factor associated with LNM in pdESCC. Metastasis in the abdominal cavity was significantly higher than in the neck in the middle and lower thoracic pdESCC (both P<0.01). LN station 102 and 7 for upper thoracic ESCC, 101 and 105 for middle thoracic ESCC, and 100 for lower thoracic ESCC were identified as high-risk stations for metastases in pdESCC compared to ESCC. Several parameters, including location and neck metastasis, were identified as risk factors of metastasis for the above sites, respectively. In conclusion, postoperative therapy should include more LN stations in pdESCC depending on risk factors of tumor metastasis individually.

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Section: Surgical Procedures and Histopathological Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation

et al. 2018

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“…It is the eighth most common malignant tumor and sixth most common cause of cancer deaths worldwide [1]. In China, the majority of cases are esophageal squamous cell carcinoma (ESCC) [2]. Surgery may be the initial treatment; however, patients with stages beyond T1b should undergo multidisciplinary evaluation and be considered for multimodality therapy.…”

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confidence: 99%

Postoperative chemoradiotherapy improves survival in esophageal squamous cell cancer with extracapsular lymph node extension

Wang¹,

Luan²,

Zhang³

et al. 2014

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In esophageal squamous cell carcinoma (ESCC), extracapsular extention (ECE) in metastatic lymph nodes portends high rate of recurrence and poor prognosis. To our knowledge, the effectiveness of postoperative chemoradiotherapy (CRT) in these patients has never been investigated. In this retrospective study, we compared the outcomes of surgery with or without postoperative chemoradiotherapy in ESCC patients with ECE. Based on log-rank stratified by T stage, postoperative adjuvant CRT significantly improved the overall survival (p=0.017) and progression free survival (p=0.002). In multivariate analysis, adjuvant CRT was identified as an independent prognostic factor (HR=0.494, CI 0.290-0.844, p=0.010). Compared with surgery alone, the CRT group had significantly fewer cases of regional recurrence (P=0.048) and overall recurrence (P=0.024). However, there was no significant difference in distant metastasis between two groups (P=0.755). In conclusion, our data suggest that the postoperative adjuvant CRT might be beneficial in selected subgroups of ESCC patients with ECE. To further verify these results, a prospective trial with a large sample size is needed.

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“…Pathology results show fibrosis or sterile nodes in previously affected lymph nodes after successful chemoradiation or systemic chemotherapy. Neoadjuvant therapy and the extent of the radiation field is therefore a new important factor that might influence surgical approach and lymphadenectomy (27). Talsma et al using the data base of the CROSS study that compared esophagectomy versus chemoradiotherapy followed by resection, came to the conclusion that the number of resected nodes have a prognostic impact on survival in patients after surgery alone.…”

Section: The Value Of Lymphadenectomy After Neoadjuvant Chemoradiothementioning

confidence: 99%

“…For squamous cell carcinoma, there are a few large retrospective and prospective cohort studies, that describe the distribution pattern of lymph node metastases (3,9,11,13,27). Most patients in these studies have T3 cancers and almost 60% has positive lymph nodes.…”

Section: Squamous Cell Carcinomamentioning

confidence: 99%

The extent of lymphadenectomy in esophageal resection for cancer should be standardized

et al. 2017

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The incidence of esophageal cancer increases, with approximately 482,000 patients diagnosed with esophageal cancer each year. Despite the growing incidence of esophageal carcinoma, the extent of the lymphadenectomy is still under discussion. Lymph node status is an important prognostic parameter in esophageal cancer and an independent predictor of survival. Surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy differs worldwide. For squamous cell cancer, Japanese surgeons have standardized the 2-or 3-field lymphadenectomy according to the location of the tumor. For adenocarcinoma, in the Western World accounting for 85% of all esophageal cancers, the type of lymphadenectomy to perform is not clear. Moreover, the use of neoadjuvant therapy may influence the mediastinal lymph nodes and the significance of the lymphadenectomy for survival. These aspects have challenged the traditional policy concerning lymphadenectomy, at least in the Western World. Furthermore, an extensive lymphadenectomy may improve survival but, on the other hand, may cause significant more morbidity. An overview of the literature on the extent of lymphadenectomy for esophageal cancer with respect to the supposed lymph node distribution patterns for squamous cell carcinoma and adenocarcinoma, the different lymph node classification systems, the commonly used surgical techniques and outcomes, and the proposal of observational cohort study to standardize the type of lymphadenectomy according to the type of tumor, location and use of neoadjuvant therapy will be provided.

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Explore the Radiotherapeutic Clinical Target Volume Delineation for Thoracic Esophageal Squamous Cell Carcinoma from the Pattern of Lymphatic Metastases

Cited by 34 publications

References 22 publications

Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation

Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation

Postoperative chemoradiotherapy improves survival in esophageal squamous cell cancer with extracapsular lymph node extension

The extent of lymphadenectomy in esophageal resection for cancer should be standardized

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