Pattern of relapse in left thoracotomy surgical treated patients with thoracic esophageal cancer and their value in target region delineation in postoperative radiotherapy
LIU Jun*, LV Chang-xing, WANG Jia-ming, WANG Chang-lu, GUO Jing-dong, LI Hong-xuan, GAO Lan-ting, FANG Wen-tao,TIAN Ye
*Department of Radiotherapy & Oncology, Second Affiliated Hospital of Soochow University, Suzhou 215004, ChinaCorresponding author:TIAN Ye, Email:dryetian@hotmail.com;L Chang-xing, Department of Radiation Oncology, Affiliated Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai Jiaotong University Esophageal Cancer Center, Shanghai 200030,China
Abstract：Objective To investigate the pattern of local recurrence in patients with thoracic esophageal cancer (EC) who have received radical surgery through a left thoracotomy, its influential factors, and the clinical target volume (CTV) for postoperative radiotherapy. Methods A retrospective analysis was performed on the clinical data of 104 patients with thoracic EC who experienced local recurrence after radical surgery through a left thoracotomy from January 2009 to June 2012. The pattern of local recurrence and its influential factors were analyzed, and the CTV for postoperative radiotherapy was determined accordingly. Results Of the 104 patients,14 had upper-thoracic EC, 68 had middle-thoracic EC, and 22 had lower-thoracic EC. According to UICC (2002) TNM classification, 10 of the patients had stage T1b cancer, 26 had stage T2 cancer, 56 had stage T3 cancer, and 12 had stage T4 cancer;48 had stage N0 cancer, and 56 had stage N1 cancer;6 had stage Ⅰ cancer, 36 had stage Ⅱa cancer, 21 had Ⅱb cancer, 40 had stage Ⅲ cancer, and 1 had stage Ⅳa cancer. In addition, 101 patients had squamous carcinoma, 2 had adenocarcinoma, and 1 had mixed squamous and small-cell carcinoma. The median time to local recurrence was 12.8 months (1—100 months). A total of 136 local recurrence sites were found in the 104 patients. Postoperative recurrence mainly occurred in the supraclavicular and upper/middle mediastinal lymph nodes (83.8%). Of the 136 local recurrence sites, 35 were in the bilateral supraclavicular areas, 64 in the upper mediastinum, 15 in the middle mediastinum, 9 in the abdominal cavity, 4 in the original tumor bed, and 9 at the anastomosis. The CTV for postoperative radiotherapy should mainly include bilateral supraclavicular areas, upper/middle mediastinum, and anastomosis. Conclusions Local recurrence mainly occurred in thebilateral supraclavicular areas, upper/middle mediastinum, and anastomosis in patients with thoracic EC who have received radical surgery through a left thoracotomy. Therefore, the CTV for postoperative radiotherapy should include the above areas.
LIU Jun*,LV Chang-xing,WANG Jia-ming et al. Pattern of relapse in left thoracotomy surgical treated patients with thoracic esophageal cancer and their value in target region delineation in postoperative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2013, 22(2): 111-114.
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