Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: Report of 549 cases

Multi-center phase II trial of chemo-radiotherapy with 5-fluorouracil, leucovorin and oxaliplatin in locally advanced esophageal cancer

“…In our study, 87% of the patients had stage III and 8% stage IVa disease; 17% had a T4 lesion. Moreover, 93% had nodal involvement which is the most important prognostic factor [40]. In the RTOG-085 study, nodal involvement was reported in only 13% of patients and there were no patients with T4 or M1a disease.…”

“…Fifty-seven patients started the concurrent phase of the treatment: 49 (83%) of them received the whole radiotherapy dose. Unplanned interruptions of more than 2 days occurred in 14 patients as a result of toxicity; 8 patients discontinued radiotherapy due to esophagitis and diarrhea after a median of 40 Gy (range [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Table 2 lists the whole incidence of toxicity during chemo-radiotherapy.…”

Efficacy Analysis of Simplified Intensity-modulated Radiotherapy with High or Conventional Dose and Concurrent Chemotherapy for Patients with Neck and Upper Thoracic Esophageal Carcinoma

“…For patients with neck or upper thoracic esophageal carcinoma, radiotherapy is a major treatment method now. Esophageal carcinoma is often accompanied with supraclavicular or superior mediastinal lymph node metastasis, and correlated with poor prognosis (Kawahara et al, 1998;Kurokawa et al, 2003;Xiao et al 2003;Xiao et al, 2005;Tachimori et al, 2011) Research showed that IMRT technique can not only elevate target dose, but possesse advantages of higher target conformity, higher dose uniformity and better protection of sensitive organs compared with conventional conformal radiotherapy (Nutting et al, 2001;Fu et al, 2004;Wu et al, 2004;Chandra et al, 2005;Wang et al, 2006;Fenkell et al, 2008). It was reported 5~7 intensity-modulated beams were more effective in target dose uniformity, target conformity and radiation dose to organs at risk when comparing the effect of IMRT with that of 3D-CRT on 5 cases of upper esophageal carcinoma using simultaneous integrate boost (Fu et al, 2004).…”

“…Neck or upper thoracic esophageal carcinoma with lymph node metastasis is a common clinical disease with poor prognosis (Kawahara et al, 1998;Kurokawa et al, 2003;Xiao et al 2003;Xiao et al, 2005;Tachimori et al, 2011). Due to hypoxia, metastatic lymph node is difficult to control by radiotherapy with the conventional dose, especially those large metastatic lymph nodes (Watarai et al, 1992).…”

Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer

“…Although the long-term survival rate associated with esophageal cancer remains at approximately 15% worldwide (1), certain recent studies have described an increase in the overall 5-year survival rate of 40% or more following esophagectomy with three-field lymphadenectomy (2), but with more complications. Postoperative radiotherapy has shown positive efficacy in lowering the recurrence rate and improving the survival rate in cases involving lymph node (LN) metastasis (3-5), although it remains unknown whether postoperative radiotherapy improves survival in all cases (3,6). Reasons for this controversy may be the undetermined target volume or insensitivity of the tissue to radiotherapy due to ischemia and hypoxia following surgery.…”