Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy

Cai, Wenjie; Xin, Peiling

doi:10.1016/j.radonc.2010.04.029

Cited by 52 publications

(71 citation statements)

References 17 publications

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“…Cervical, middle and upper mediastinal LN had higher metastatic rates which correlate with the findings of Cai et al (10). In addition, the metastatic rates of 1R (43.7%) and Station 7 (34.1%) were higher than those of 2R (25.4%) and 4R (21.4%), while 1L (15.1%), 2L (14.3%), 4L (15.1%) and Station 5 (12.7%) had relatively low metastatic rates, which is consistent with the results of Liu et al (16).…”

Section: Discussionsupporting

confidence: 89%

“…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. To our knowledge, to date, only Cai et al (10) have studied the pattern of relapse in patients who received esophagectomy with two-field or three-field lymphadenectomy for thoracic esophageal cancer and provided some reference for the determination of the postoperative radiotherapy target volume for esophageal cancer. Based on this study, we further analyzed the locoregional recurrence patterns following radical esophagectomy focussing on two-field LN dissection for thoracic esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 89%

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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“…Even among patients with lower thoracic ESCC, the incidence of SCV LN recurrence was as high as 33.8%. Similar to finding of Wu and colleagues, Cai et al (6) performed a study to investigate the patterns of regional LN recurrence after radical surgery for ESCC. The results showed that SCV areas were the most common site of recurrence, followed by mediastinal and abdominal areas.…”

Section: Original Articlementioning

confidence: 77%

“…The available data indicates that postoperative radiotherapy could reduce locoregional recurrence and improve overall survival of ESCC patients. Furthermore, the major of studies suggested that the SCV areas should be included in prophylactic radiotherapy for patients with upper, middle, and lower thoracic EC (6,(11)(12)(13).…”

Section: Background: To Map Detail Distribution Of Metastatic Supraclmentioning

confidence: 99%

“…Neoadjuvant therapy followed by surgery is the standard treatment for patients with resectable thoracic esophageal squamous cell carcinoma (ESCC) (3)(4)(5). However, most patients in China generally prefer surgery to neoadjuvant therapy as their initial treatment (6,7). Surgery alone has shown rather disappointed survival rates, which the 5-year survival rate is only 20-40%.…”

Section: Introductionmentioning

confidence: 99%

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Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

et al. 2016

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Background: To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV).Methods: A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results: In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV. Conclusions: According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas. was the most common site of recurrence regardless of the tumor location. Even among patients with lower thoracic ESCC, the incidence of SCV LN recurrence was as high as 33.8%. Similar to finding of Wu and colleagues, Cai et al. (6) performed a study to investigate the patterns of regional LN recurrence after radical surgery for ESCC. The results showed that SCV areas were the most common site of recurrence, followed by mediastinal and abdominal areas. As such, several studies also indicated that the incidence of SCV LN recurrence was a common site of recurrence after radical surgery (range, 33.3% to 75.0%) (7-9). The available data indicates that postoperative radiotherapy could reduce locoregional recurrence and improve overall survival of ESCC patients. Furthermore, the major of studies suggested that the SCV areas should be included in prophylactic radiotherapy for patients with upper, middle, and lower thoracic EC (6,(11)(12)(13).However, delineating the SCV region lymph nodal clinical target volume (CTVn) for esophageal carcinoma remains a challenging task. Currently, data documenting the precise location of involved SCV region LN in esophageal carcinoma are scarce. It is desirable to define detailed involvement patterns in the SCV region, so that these areas can be better covered and treated with an adequate radiation dose. Here, we describe the distribution of SCV LN metastasis for esophageal carcinoma patient after surgery according to computed tomography (CT) imaging in our institution, then analyzed the anatomic distribution of SCV region LN to outline the spatial and probabilistic distributions of LN, and to provide data for an evidence-based approach to SCV region radiation therapy field design. Thus, we could minimize inconsistency of irradiation field and to achieve precise radiotherapy of the SCV region for postoperative radiotherapy. Methods Patient populationWe retrospectively reviewed the...

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Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus

et al. 2020

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Background Patterns of failure following definitive CRT (dCRT) are different as compared to neoadjuvant chemoradiotherapy (NACRT) with increased locoregional failures documented with dCRT. Aim To document failure patterns in patients with esophageal carcinoma treated with neoadjuvant and definitive intent radiation strategies. Methods Subjects were 123 patients treated with two chemoradiotherapy strategies. Group 1 (n = 99) underwent dose escalated definitive chemoradiotherapy (dCRT), Group 2 (n = 24) received neoadjuvant chemoradiotherapy (NACRT) followed by surgery. Cumulative incidence of locoregional failure (LRF), local failure (LF), regional lymph node failure (RLNF), and distant metastasis (DM) were computed; differences between the groups was evaluated using log rank test. Univariable and multivariable predictors of failure were identified using Cox regression analysis. Results Cumulative LRF: 64% in Group 1 vs 35% in Group 2 (P = .050). Cumulative LF: 59% in Group 1 vs 12% in Group 2 (P = .000). Cumulative RLNF: 30% in Group 1 vs 24% in Group 2 (P = .592). Most common RLNF: mediastinum for both groups (6% vs 12.5%, respectively). Distant metastasis: 40.4% Group 1 vs 17% Group 2 (P = .129), predominantly lung (Group 1, 5%), and nonregional nodes (Group 2, 8.3%). Univariate analysis identified age ≤50, absence of concurrent chemotherapy, dose ≤50 Gy, and incomplete radiotherapy to predict higher odds of LRF and DM for Group 1; absence of comorbidities predicted for lower odds of LRF for Group 2. Age ≤50 predicted for higher odds of RNLR for Group 1, while absence of comorbidities predicted for lower odds of RNLR in Group 2. Multivariate analysis identified age ≤50, incomplete radiotherapy, and absence of concurrent chemotherapy to predict higher odds of LRF for Group 1. Age ≤50, absence of concurrent chemotherapy predicted higher odds of DM for Group 1. Absence of comorbidity predicted lower odds of LRF in Group 2. Conclusion LRF is common in both groups, with LF being predominant in dCRT as opposed to RNLF in NACRT. Age ≤50, absence of concurrent chemotherapy is a predictor of LRF and DM in dCRT.

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Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy

Cited by 52 publications

References 17 publications

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

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

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus

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