Number and Location of Positive Nodes, Postoperative Radiotherapy, and Survival After Esophagectomy With Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma

Chen, Junqiang; Pan, Jianji; Xiao, Zheng; Zhu, Kunshou; Li, Jiancheng; Chen, Mingqiang; Wang, Jiezhong; Liao, Zhongxing

doi:10.1016/j.ijrobp.2010.08.037

Cited by 76 publications

(89 citation statements)

References 15 publications

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“…When stratifying based on stage, however, there was a significant survival benefit with adjuvant RT for stage III patients. In a series of retrospective studies, Chen and colleagues [18,19] analyzed some clinical data of a large sample of patients with ESCC, and reported that postoperative RT was associated with better survival for patients with node-positive ESCC. In further analysis, they found the main beneficiaries of postoperative RT were the patients with three or more positive nodes.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…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)(4)(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.…”

Section: Introductionmentioning

confidence: 99%

“…A large T-shaped field was first used which encompassed the bilateral supraclavicular fossi, mediastinum and left gastric nodes. In recent years, the large T-shaped field was modified into a smaller T-shaped field to reduce unacceptable complication rates by omitting the left gastric artery drainage region (5). Certain published studies have focussed on LNs found to be affected during surgery (7)(8)(9) while little work has been done to study the LN metastasis pattern following surgery and its influence on the determination of the target volume of postoperative radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2012

Oncology Letters

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Abstract.Postoperative radiotherapy has shown positive efficacy in lowering the recurrence rate and improving the survival rate in cases involving lymph node (LN) metastasis. However, the radiotherapy target volume remains controversial. Certain published studies have paid more attention to LNs found to be affected during surgery, while little effort has been made to study the LN metastatic pattern following surgery and its influence on the determination of the target volume of postoperative radiotherapy. In this study, the locoregional recurrence of esophageal squamous cell cancer was examined in 134 patients receiving radical surgery with two-field lymph node dissection from 2004 to 2009. In the 134 cases of recurrence, LN metastasis occurred in 126 patients (94.0%) while 13 patients (9.7%) developed anastomotic recurrence and 5 patients (3.7%) experienced tumor bed recurrence. The difference among the groups was statistically significant (P= 0.000). In the 126 cases with lymph node metastasis, the mediastinal metastasis rate (80.2%) was significantly higher compared with the rate of supraclavicular metastasis and abdominal metastasis (P= 0.000). A significant difference was identified between right and left supraclavicular LN metastasis (31.7% vs 16.7%, P= 0.005). Furthermore, the difference between the metastatic rates in the upper (73.8%), middle (39.7%) and lower mediastinum (1.6%) was statistically significant (P= 0.000). Nevertheless, no significant correlation between the rate of LN metastasis was observed in the supraclavicular, mediastinal and abdominal regions for upper, middle and lower thoracic carcinomas (P= 0.404, P= 0.718 and P= 0.169, respectively). Based on our data, LN metastasis is the major locoregional recurrence pattern for esophageal squamous cell cancer following radical surgery. The high-risk lymphatic drainage areas include the supraclavicular nodes, recurrent laryngeal nerve nodes, azygos nodes and subcarinal nodes. IntroductionSurgery is the mainstay treatment for resectable 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. A large T-shaped field was first used which encompassed the bilateral supraclavicular fossi, mediastinum and left gastric nodes. In recent years, the large T-shaped field was modified into a smaller T-shaped field to reduce unacceptable complication rates by omitting...

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“…Several reports suggest that postoperative radiotherapy (PORT) is indicated for local control in patients with esophageal cancer who do not receive CCRT but who have positive nodes [9][10][11][12]. After a systematic review, Jabbour and Thomas [11] suggested an improvement in local control and a possible survival improvement with the use of PORT.…”

Section: Introductionmentioning

confidence: 99%

Do We Need to Add Postoperative Radiotherapy in Patients Undergoing Trimodality Therapy for Esophageal Squamous Cell Carcinoma with Positive Lymph Nodes Disease?

et al. 2017

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Background: The role of adjuvant radiotherapy for positive lymph nodes (LN) in patients with esophageal cancer who received neoadjuvant concurrent chemoradiotherapy (CCRT) is not well established. This study is aimed at determining the impact of positive LN and the survival benefit of postoperative radiotherapy (PORT) after CCRT plus surgery on esophageal cancer patients. Methods: Seventy patients with positive LN after neoadjuvant CCRT followed by esophagectomy were enrolled in the study. Patients were grouped into surgery alone following neoadjuvant CCRT (n = 41) and surgery plus PORT following neoadjuvant CCRT (n = 29) groups. The preoperative radiation dose was 36-45 Gy (mean 40 Gy) and the postoperative radiation dose was 20 Gy in 10 fractions. Results: The 5-year survival rate and mean survival was 40% and 58.6 ± 53.9 months for patients with a pathologic complete response (pCR) compared with 8.3% and 22.7 ± 35.5 months, respectively, for non-pCR patients (p = 0.026). Local and distant recurrent patterns were similar for patients who did and did not receive PORT (p = 0.876). The mean survival did not differ significantly between the 2 groups (p = 0.889). Pathological complete response to CCRT was the only significant factor influencing survival (p = 0.026). Conclusions: Postoperative RT did not improve survival in patients with positive LN after CCRT followed by curative surgery for esophageal cancer.

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Number and Location of Positive Nodes, Postoperative Radiotherapy, and Survival After Esophagectomy With Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma

Cited by 76 publications

References 15 publications

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

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

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

Do We Need to Add Postoperative Radiotherapy in Patients Undergoing Trimodality Therapy for Esophageal Squamous Cell Carcinoma with Positive Lymph Nodes Disease?

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