Extent of prophylactic postoperative radiotherapy after radical surgery of thoracic esophageal squamous cell carcinoma

Abstract

The aim of this study was to assess if the entire mediastinum (M), the bilateral supraclavicular area (S), and the left gastric area (L) should be all included in the irradiation volume. The clinical data of 204 patients with thoracic esophageal squamous cell carcinoma who had undergone prophylactic postoperative radiotherapy after radical surgery were retrospectively reviewed. They were classified into four groups: group A, 26 patients with irradiated M alone; group B, 139 patients with irradiated M + S; group C, 10 patients with irradiated M + L; and group D, 29 patients with irradiated M + S + L. The 5-year disease-free survival rates were 36% in group A, 31% in group B, 40% in group C and 44% in group D (chi2=3.05, P =0.39), respectively. Multivariate analysis revealed that the irradiated extent was not a significant influential factor (hazard ratio=0.84, 95% confidence interval, 0.69-1.03, P =0.10). None of 43 patients without the L irradiated and with disease in the upper and middle upper thirds (defined in middle third but with upper third invaded), and one of 83 patients without the L irradiated and with disease in the middle third only thoracic esophagus were shown to have abdominal lymph node metastasis. Supraclavicular lymph node metastasis in patients in the lower and middle lower thirds (defined in middle third but with lower third invaded) were, respectively, 1/43 and 1/18 whether the S was irradiated or not. It seems unnecessary that the L be irradiated when the primary site is in the upper, middle, and middle upper thirds of the thoracic esophagus after radical surgery. Similarly, S may be unnecessarily irradiated in the lower and middle lower thirds.

Transforming growth factor-β1-induced epithelial-mesenchymal transition in human esophageal squamous cell carcinoma via the PTEN/PI3K signaling pathway

“…It has a high incidence rate in China, especially in Henan Province, with a poor prognosis (1)(2)(3). In spite of significant advancement in early diagnosis, surgical intervention as well as local and systemic adjuvant therapies, the majority of cancer deaths are attributable to tumor invasion and metastasis that are resistant to available therapies (4,5). Notably, it was found that malignant tumor cells increased their cell invasion and motility in a manner similar to the epithelial-to-mesenchymal transition (EMT) (6).…”

Stat3 promotes invasion of esophageal squamous cell carcinoma through up-regulation of MMP2

“…Despite the improving combination of surgery, radiotherapy, and chemotherapy, the outcome of esophageal squamous cell carcinoma (ESCC), especially the metastatic ones, remains disappointing [1]. To establish novel diagnostic and therapeutic strategies against this deadly disease, it is essential to understand its molecular pathology.…”

“…Esophageal carcinoma is the most common malignant tumor in northern China [1]. Despite the improving combination of surgery, radiotherapy, and chemotherapy, the outcome of esophageal squamous cell carcinoma (ESCC), especially the metastatic ones, remains disappointing [1].…”

Radiotherapy With or Without Concurrent Chemotherapy for Lymph Node Recurrence After Radical Surgery of Thoracic Esophageal Squamous Cell Carcinoma

“…These observations gave us the impetus to audit our data to ascertain whether treatment intensification increased the therapeutic ratio. Therefore, on the basis of our former studies (12,13), we retrospectively investigated the outcome of radiochemotherapy (RC) for lymph node recurrence after radical surgery of thoracic esophageal squamous cell carcinoma.…”