Abstract Objective To analyze the doses to lymph node drainage areas during involved-field irradiation (IFI) in three-dimensional conformal radiotherapy (3DCRT) for esophageal cancer (EC). Methods A retrospective analysis was performed on the clinical data of 81 patients with medically inoperable thoracic EC who received IFI from 2000 to 2004. The lymph node drainage areas were delineated based on the lesions, and the dose-volume parameters of the planning target volume (PTV) of each lymph node drainage area was analyzed. Results The median values of V30, V35, V40, V45, and V50 were 73%, 70%, 67%, 64%, and 58%, respectively. The prescribed dose was not significantly correlated with V30 and V35(P=0.215,0.054), but significantly correlated with V40 and V50(P=0.027,0.002,0.000);the number of radiation fields was not significantly correlated with V30 and V45(P=0.438,0.535,0.425,0.313), but significantly correlated with V50(P=0.045);the length of lesion on barium meal examination and volume of PTV were significantly correlated with V30 and V50(all P<0.05). The one-way analysis of variance showed that the Vx value of upper-thoracic segment was greater than those of middle-and lower-thoracic segments (P=0.028,0.045);the values of V30 and V35 varied significantly between different lesions, but there were no significant differences in the values of V40 and V50(P=0.076,0.173,0.695). The Vx value had no significant impact on the long-term survival of patients (all P>0.05). Conclusions The lymph node drainage areas of EC receive a considerable dose with IFI in 3DCRT, which may play a certain role in preventing regional lymph node metastasis, but more clinical studies are needed.
Shen Wenbin*,Gao Hongmei,Zhu Shuchai et al. Analysis of doses to lymph node drainage areas during involved-field irradiation for esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 220-223.
Shen Wenbin*,Gao Hongmei,Zhu Shuchai et al. Analysis of doses to lymph node drainage areas during involved-field irradiation for esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 220-223.
[1] Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial (RTOG 85-01).Radiation Therapy Oncology Group[J]. JAMA,1999,28:1623-1627. [2] Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123(Radiation Therapy Oncology Group 94—05) phase Ⅲ trial of combined-modality therapy for esophageal cancer:high-dose versus standard-dose radiation therapy[J].J Clin Oncol,2002,20:1167-1174. [3] Ajani JA, Winter K, Komaki R, et al. Phase Ⅱ randomized trial of two nonoperative regimens of induction chemotherapy followed by chemoradiation in patients with localized carcinoma of the esophagus:RTOG 0113[J].J Clin Oncol,2008,26:4551-4556. [4] Ma JB, Song YP, Yu JM,et al. Feasibilityof involved-field conformal radiotherapy for cervical and upper-thoracic esophageal cancer[J]. Onkologie,2011,34:599-604. [5] Huang W, Li B, Gong H, et al. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma:a report of 1077 cases[J]. Radiother Oncol,2010,95:229-233. [6] Chen J, Liu S, Pan J, et al. The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma[J].Eur J Cardiothorac Surg,2009,36:480-486. [7] Zhao KL, Ma JB, Liu G, et al. Three-dimensional conformal radiation therapy for esophageal squamous cell carcinoma:is elective nodal irradiation necessary[J]? Int J Radiat Oncol Biol Phys,2010,76:446-451. [8] Button MR, Morgan CA, Croydon ES, et al. Study to determine adequate margins in radiotherapy planning for esophageal carcinoma by detailing patterns of recurrence after definitive chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys,2009,73:818-823. [9] 张萍,谢聪颖,吴式琇.紫杉醇联合铂类与放疗同步治疗局部晚期食管癌的临床研究[J].中华肿瘤杂志,2007,29:773-777. [10] Kawaguchi Y, Nishiyama K, Miyagi K, et al. Patterns of failure associated with involved field radiotherapy in patients with clinical stage Ⅰ thoracic esophageal cancer [J]. Jpn J Clin Oncol,2011,41:1007-1012. [11] Withers HR, Peters LJ, Taylor JM, et al. Dose-response relationship for radiation therapy of subclinical disease[J]. Int J Radiat Oncol Biol Phys,1995,31:353-359. [12] Withers HR, Peters LJ, Taylor JM, et al. Dose-response for subclinical disease in response to Dr. Ben-Josef[J]. Int J Radiat Oncol Biol Phys,1995,32:1267-1268. [13] Ji K, Zhao LJ, Yang CW, et al. Three-dimensional conformal radiation for esophageal squamous cell carcinoma with involved-field irradiation may deliver considerable doses of incidental nodal irradiation[J]. Radiat Oncol,2012,27:200-208. [14] Nakamura T, Hatooka S, Kodaira T, et al. Determination of the irradiation field for clinical T1-T3N0M0 thoracic/abdominal esophageal cancer based on the postoperative pathological results[J].Jpn J Clin Oncol,2009,39:86-91.
2014, Vol. 23 
