[an error occurred while processing this directive] | [an error occurred while processing this directive]
Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery
Chen Junqiang, Chen Ming, Lin Yu, Su Tingfeng, Li Jiancheng,Li Jiancheng,Wu Junxin,Pan Jianji
Department of Radiation Oncology,Fujian provincial tumor hospital, Teaching hospital of Fujian Medical University,Fuzhou 350014,China
Abstract Objective To analyze the regions of abdominal lymph node metastasis in recurrent thoracic esophageal squamous cell carcinoma (TE-SCC) after radical surgery, and to guide the design of target volume in postoperative adjuvant radiotherapy. Methods Patients with TE-SCC who were admitted to our hospital from February 2005 to April 2013 were enrolled as subjects. All patients were diagnosed with abdominal lymph node metastasis by imaging after R0 radical surgery. The exact regions of abdominal lymph node metastasis were classified according to the 7th edition of American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer, and then retrospectively analyzed. The difference of two group was analyzed by χ2 test. Results Among the 1593 eligible patients, 148(9.3%) were diagnosed with abdominal lymph node metastasis after surgery. In the 148 patients, the abdominal lymph node metastasis rates in the upper, middle, and lower thoracic esophagus were 2.3%, 7.8%, and 26.6%, respectively (P=0.000);the incidence rates of pathological stages T1/2 and T3/4 were 8.7% and 9.5%, respectively (P=0.601);the incidence rates of 0-2 and ≥3 metastatic lymph nodes in postoperative pathological examination were 4.8% and 20.1%, respectively (P=0.000). The abdominal lymph node metastasis rate was the highest in the para-aortic lymph node (16a2), followed by para-aortic lymph node (16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery (64.9%, 41.2%, 37.8%, 32.4%, and 20.9%), yielding an overall metastasis rate of 91.9%. Conclusions The major regions of abdominal lymph node metastasis in esophageal carcinoma after radical surgery include para-aortic lymph nodes (16a2 and 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery. These regions are the abdominal target volumes of postoperative adjuvant radiotherapy.
. Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery[J]. Chinese Journal of Radiation Oncology, 2016, 25(2): 105-108.
. Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery[J]. Chinese Journal of Radiation Oncology, 2016, 25(2): 105-108.
[1]Xiao ZF,Yang ZY,Liang J,et al. Value of radiotherapy after radical surgery for esophageal carcinoma:a report of 495 patients[J].Ann Thorac Surg,2003,75(2):331-336.DOI:10.1016/S0003-4975(02)04401-6. [2]Nakagawa S,Kanda T,Kosugi SI,et al. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy[J].J Am Coll Surg,2004,198(2):205-211.DOI:10.1016/j.jamcollsurg.2003.10.005. [3]Cai WJ,Xin PL.Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy[J].Radiother Oncol,2010,96(1):104-107.DOI:10.1016/j.radonc.2010.04.029. [4]Doki Y,Ishikawa O,Takachi K,et al. Association of the primary tumor location with the site of tumor recurrence after curative resection of thoracic esophageal carcinoma[J].World J Surg,2005,29(6):700-707.DOI:10.1007/s00268-005-7596-4. [5]葛红,蒋月,刘劲松.胸段食管鳞癌术后放疗靶区的确定[J].临床肿瘤学杂志,2005,10(5):526-527,544. Ge H,Jiang Y,Liu JS.Postoperative radiotherapy target voume of thoracic esophageal squamous cell cancer[J].Chin Clin Oncol,10(5):526-527,544. [6]Xiao ZF,Yang ZY,Miao YJ,et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy:report of 549 cases[J].Int J Radiat Oncol Biol Phys,2005,62(1):82-90.DOI:10.1016/j.ijrobp.2004.08.046. [7]Chen JQ,Zhu J,Pan JJ,et al. Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus[J].Ann Thorac Surg,2010,90(2):435-442.DOI:10.1016/j.athoracsur.2010.04.002. [8]Chen JQ,Liu SY,Pan JJ,et al. The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma[J].Eur J Cardiothorac Surg,2009,36(3):480-486.DOI:10.1016/j.ejcts.2009.03.056. [9]Chen JQ,Pan JJ,Liu J,et al. Postoperative radiation therapy with or without concurrent chemotherapy for node-positive thoracic esophageal squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2013,86(4):671-677.DOI:10.1016/j.ijrobp.2013.03.026. [10]Shimada H,Kitabayashi H,Nabeya Y,et al. Treatment response and prognosis of patients after recurrence of esophageal cancer[J].Surgery,2003,133(1):24-31.DOI:10.1067/msy.2003.31. [11]Kato H,Miyazaki T,Nakajima M,et al. Value of positron emission tomography in the diagnosis of recurrent oesophageal carcinoma[J].Br J Surg,2004,91(8):1004-1009.DOI:10.1002/bjs.4595. [12]Edge SB,Byrd DR,Compton CC,et al. AJCC cancer staging manual[M].7th ed. New York:Springer,2009. [13]刘文健,孔莉,于金明,等.胸段食管鳞癌术后复发模式及辅助治疗的意义[J].中国肿瘤临床,2010,37(23):1358-1361.DOI:10.3969/j.issn.1000-8179.2010.23.010. Liu WJ,Kong L,Yu JM,et al. Pattern of recurrence following complete resection of thoracic esophageal squamous cell carcinoma and significance of adjuvant therapy[J].Chin J Clin Oncol,2010,37(23):1358-1361.DOI:10.3969/j.issn.1000-8179.2010.23.010. [14]章文成,王奇峰,肖泽芬,等.胸段食管鳞癌根治术后失败模式对放疗野设计的指导作用[J].中华放射肿瘤学杂志,2012,21(1):38-41.DOI:10.3760/cma.j.issn.1004-4221.2012.01.012. Zhang WC,Wang QF,Xiao ZF,et al. Patterns of failure after complete resection of thoracic esophageal squamous cell carcinoma:implications for postoperative radiation therapy volumes[J].Chin J Radiat Oncol,2012,21(1):38-41.DOI:10.3760/cma.j.issn.1004-4221.2012.01.012. [15]Qiao XY,Wang W,Zhou ZG,et al. Comparison of efficacy of regional and extensive clinical target volumes in postoperative radiotherapy for esophageal squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2008,70(2):396-402.DOI:10.1016/j.ijrobp.2007.06.031.
2016, Vol. 25 
