Postoperative Recurrence Of Thoracic Esophageal Squamous Cell Carcinoma And Radiotherapy Target

OBJECTIVE:To analyse the recurrent patterns of thoracic esophageal carcinoma and relationship between lymph node status at operation and the lymph nodes recurrent site.METHODS:83 patients who had undergone resection of thoracic esophageal carcinoma from 2004 to 2012.Sites of failure on different primary location and recurrent lymph node metastasis rate in each site were documented.RESULT:In 83 thoracic esophageal carcinomas that underwent curative surgery, lymph node metastasis rate, anastomosis recurrence rate and tumor bed recurrence rate was 93.98%,14.46% and 6.02%, respectively. As to the cases with lymph node metastasis (LNM), mediastinal metastasis rate, supraclavicular metastasis rate and abdominal lymph node metastasis rate was 66.3% ,37.3% and 13.3%.Patients with upper or middle thoracic esophageal cancer had high proporation of intrathoracic recurrence(81.8%,80.8%).Patients with lower thoracic esophageal cancer had more intrathoracic reccurence(45%) and abdominal LNM recurrence(30%). Superior mediastinal lymph node metastasis rate, middle mediastinal nodes rate and inferior mediastinal nodes rate was 59.0%,28.9% and 2.4%, respectively. There was significant difference among the three roups(X2=65.108, P=0.000). There was significant difference in recurrence rates of mediastinal metastasis rate in different part(X2=13.911, P=0.001).There was significant difference in different stages after upraclavicular lymph node recurrence(P=0.021). Pathological lymph node status has nothing to do with mediastinal metastasis (X2=1.033, P=0.310),whereas the presence of abdominal LNM was significantly associated with loco regional recurrence (X2=5.738, P=0.017).CONCLUSION:The main characteristics of recurrence may be lymph node metastasis for thoracic esophageal carcinoma after radical surgical resection. Rates of LNM were highest in the mediastinal area. The presence of abdominal LNM at operation may be associated with corresponding loco regional recurrence, while the presences of other LNM were not. According to recurrence site, the following radiation targets recommended:when the tumor was located at the upper in the middle thoracic esophagus with negative N status, the mediastinum, the tumor bed and the supraclavicular region should be included as postoperative RT target; when the tumor was located at the middle thoracic esophagus with positive N or located at the lower thoracic esophagus, the abdominal lymph node should be added.The supraclavicula and upper mediastinal area of patients with stage Ⅲ is an important preventive area.OBJECTIVE:To compare recurrence patterns of the single operation on esophageal carcinoma with the operation plus post-operation radiotherap in order to design the radiation field in postoperation radiotherapy. Methods We reviewed local-regional recurrence for 115 cases with thoracic esophageal carcinoma after surgical resection, including 83 cases without prophylactic radiotherapy and 32 cases with radiotherapy from 2004 to 2012 and analysed local regional recurrence patterns.RESULT:Recurrence in lymph nodes was 94.0% among patients who did not receive postoperative radiotherapy, and it was 90.6% among those who did. Rates of lymph node recurrence(LNM) were highest in the mediastinal area(66.3%、59.4%).Superior mediastinal lymph node metastasis rate was higher than middle and inferior mediastinal nodes rate, respectively.The rate of recurrence in the superior mediastinal lymph node was higher among patients who did not receive radiotherapy than among those who did(x2=5.35,P=0.038).The recurrent proportion of the superior mediastinal lymph node in the patients of preoperative superior mediastinal lymph node metastasis without radiotherapy is higher than that with radiotherapy (X2=5.850, P=0.016). Compared to patients of middle mediastinal LNM (X2=183, P=0.669), abdominall LNM (x2=0.130, P=0.547) but without postoperative radiotherapy, the recurrent proportion of corresponding lymph node was not significantly lower in patients with postoperative radiotherapy. The LNM outside the field of radiation were positively correlated with the T stage(X2-11.276, P=0.010), respectively. The rates were negatively correlated with tumor differentiation,X2=9.197, P=0.010.Littel correlation was found between the rates and the location of tumor,X2=5.290, P=0.071.CONCLUSION:The main characteristics of recurrence may be lymph node metastasis for thoracic esophageal carcinoma after radical surgical resection. Postoperative radiotherapy play role in reducing the recurrence in patients with the superior mediastinal LNM. Postoperative radiotherapy could not significantly reduce the recurrent proportion of middle mediastinal, supraclavicular and abdominall LNM. The radiation targets for esophageal carcinoma from different sites should include supraclavicular region and superior and middle mediastinum, when the tumor was located at the middle thoracic esophagus or located at the lower thoracic esophagus, the abdominal lymph node should be added.