Abstract：Objective To evaluate the efficacy of salvage radiotherapy for supraclavicular lymph node metastasis (SLNM) after initial treatment in patients with esophageal cancer. Methods A total of 117 patients with SLNM after radical resection for esophageal cancer were enrolled as subjects from 2006 to 2012. All patients received three-dimensional radiotherapy with 1.8-2.0 Gy per cycle, 5 cycles a week. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox model was used for multivariate analysis. Results The follow-up rate was 100%. In all the patients, the 1-and 3-year overall survival (OS) rates were 38.5% and 14.1%, respectively. The 1-and 3-year OS rates were significantly higher in patients treated with salvage radiotherapy or radiochemotherapy (n=100) than in patients without any salvage treatment (n=17)(42% vs. 18%,P=0.008;17% vs. 0%, P=0.008). The patients treated with radiochemotherapy (n=32) had significantly higher 1-and 3-year OS rates than those treated with radiotherapy alone (n=68)(59% vs. 34%, 36% vs. 11%, P=0.002) or without any salvage treatment (n=17)(59% vs. 18%, 36% vs. 0%, P=0.002). Patients without visceral metastasis (n=80) had significantly higher 1-and 3-year OS rates than those with visceral metastasis (n=37)(44% vs. 27%,P=0.002;22% vs. 0%,P=0.002). Patients with supraclavicular doses of ≥60 Gy in salvage radiotherapy (n=75) had significantly higher 1-and 3-year OS rates than those with supraclavicular doses of<60 Gy in salvage radiotherapy (n=25)(75% vs. 25%,P=0.000;24% vs. 8%,P=0.000). The multivariate analysis using the Cox model showed that supraclavicular doses of ≥60 Gy, mediastinal metastasis, visceral metastasis, and salvage treatment method were independent factors for survival (P=0.001,0.015,0.009,0.025). Conclusions Salvage radiotherapy can improve the survival of patients with SLNM in esophageal cancer. Salvage radiotherapy or radiochemotherapy is highly recommended for patients with SLNM alone. A radiation dose of ≥60 Gy in salvage radiotherapy improves survival in patients.
Zhou Zhiguo,Zhen Chanjun,Zhang Ping et al. A clinical study of salvage radiotherapy for supraclavicular lymph node metastasis in patients with esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(8): 813-817.
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