Study On The Adjuvant Radiation Therapy Of Thoracic Esophageal Carcinoma After Path Left Chest Surgery

Objective: To analyze the local recurrence pattern of esophageal cancer after curativeresection, and to explore the indication of postoperative radiotherapy and to explore theclinical target volume for thoracic esophageal cancer after curative resection.Methods: The clinical data of75patients who suffered from local recurrence aftercurative esophagecotomy from Jan2009to Jun2011were retrospectively analyzed. Theregularity of local recurrence were stratified and analyzed.Results: Of the seventy-five patients who were proved local recurrence,8caseslocated in upper-thoracic esophagus and53cases located in middle-thoracic esophagus and14located in lower-thoracic esophagus before resection. According to UICC2002TNMclassification,5patients were stage I,26patients were stage IIa,7patients were stage IIb,35patients were stage III,1patients was stage IVa,1patients were stage IVb respectively.Only nine patients underwent cervical lymphadenectomy,66patients hadn’t done cervicallymphadenectomy; Recurrent laryngeal nerve lymph nodes were removed in14cases andnot removed in61cases during operation. Of the local recurrence position,27cases werepresented in supraclavicular area,47cases and11cases were presented in uppermediastinum and middle mediastinum respectively,4cases were detected celiac lymphnode metastasis, anastomosis recurrence were found in8cases.Conclusion: Local recurrence were mainly recurred in supraclavicular area andupper-middle mediastinum and anastomotic stoma. The patients who suffered from localrecurrence were mainly those who didn’t receive recurrent laryngeal nerve lymph nodesresection and cervical lymphadenectomy. Therefore we suggest that postoperative prophylactic radiotherapy may be selected according to operative modes and TNM staging,the postoperative radiation field should include supraclavicular and upper-middlemediastinum and anastomotic stoma. Objective: To analyze the local recurrence pattern of esophageal cancer patients whohave received left chest notches, and to explore the clinical target volume for thoracicesophageal cancer after left transthoracic resection.Methods: The clinical data of104patients who suffered from local recurrence afterleft transthoracic esophagectomy from Jan2009to Jun2012were retrospectively analyzed.The regularity of local recurrence were stratified and analyzed.Results: Of the104patients who were proved local recurrence,14cases located inupper-thoracic esophagus and68cases located in middle-thoracic esophagus and22caseslocated in lower-thoracic esophagus before resection. According to UICC2002TNMclassification,6patients were stage I,36patients were stage IIa,21patients were stageIIb,40patients were stage III,1patients was stage IVa, respectively. The medianrecurrence time from surgery was12.8±12.9months. The majority recurrence positionwere bilateral supraclavicular area and upper-middle mediastinum, represented83.8%recurrence rate of all.Conclusion: Local recurrence were mainly recurred in supraclavicular area andupper-middle mediastinum and anastomotic stoma. Therefore we suggest thatpostoperative prophylactic radiotherapy field should include supraclavicular andupper-middle mediastinum and anastomotic stoma. Objective: To analyze the effect of T-shape field prophylactic postoperativeradiotherapy following complete left thoracotomy resection with thoracic esophagealsquamous cell carcinoma (ESCC), to determine the appropriate target volumes and todetermine whether T-shape field irradiation is suitable for these patients.Methods: A total of88consecutive patients discharged from Shanghai ChestHospital following R0resection of left thoracotomy between January2010and December2011were treated with T-shape field prophylactic postoperative radiotherapy. The T-shapefield (CTV) encompassed the bilateral supraclavicular region, upper-middle mediastinallymph nodes and the anastomosis site. The radiation dose was5000cgy with25fractionswithin5to6weeks.Recurrence patterns and overall survival rate and progression-free-survival (PFS) rate were analysed. Out-of-field regional nodal recurrence was defined as arecurrence in an initially uninvolved regional lymph node.Results: Of the88patients,17cases located in upper-thoracic esophagus and51cases located in middle-thoracic esophagus and20cases located in lower-thoracicesophagus before resection.According to UICC2002classification, stage IIA and IIB andIII were36and11and41cases, respectively. All88patients who made up the studypopulation tolerated the irradiation well. No acute or late grade4or5toxicity wasobserved. Fifteen of the88patients (17%) showed treatment failure. Two of the fifteendeveloped an in-field recurrence only, two patients developed out-of-field nodal recurrenceonly,9patients developed distant metastasis without regional failure and two patientsdeveloped distant metastasis with in-field recurrence. The distant recurrence mainlylocated at liver, bone, and lung.The disease-free-survival (DFS) rate at1,2, and3yearswas93.2%and80.8%and56.0%, the overall survival rate at1,2, and3years was98.9% and84.4%and58.8%,respectively.Conclusion: The local-regional failure rate is relatively low in patients treated withT-shape field prophylactic postoperative radiotherapy following radical left thoracotomyresection for esophageal SCC. Distant metastases rate was still very high and distantmetastases remained the predominant problem for these patients. The acute and late sideresponse was acceptable and no serious late response was observed.