Study The Extent Of Microscopic Extension In Esophageal Carcinoma And The Meaning To Radiotherapy

Objective:Radiotherapy,as a kind of local treatment,is oneof the most important method of esophageal carcinoma.Thetarget in radiotherapy is the key factor to decrease localrecurrence.In recent years,three-dimensional conformalradiotherapy is presented which makes the cubic shape of highdose area of radiotherapy conformal to the tumor'shape,andmeanwhile leads to the least dose radiation to surrouding normaltissue.However,the three-dimensional conformal radiationtherapy (3-DCRT) doesn't reach matural stage and has manyproblems to solve.For example how to determine thetumor'edge;how much we should extend the gross tumorvolume (GTV) to the clinical target volume (CTV). Researchshows that esophageal carcinoma has multicentric carcinomalesion and severe dysplasa and direct intramural infiltrationcharacters.Research multicentric carcinoma lesion and serevedysplasa and direct intramural infiltration of esophagealcarcinoma which guide radiotherapy doctor to profile taget todetermine the clinical target volume. Therefore,preciselocalization is performed by increasing local control ratio,andhence the living quality is improved. In this thesis, we try toresearch multicentric carcinoma lesion(ML) ,severedysplasa(SD) and direct intramural infiltration(DI) ofesophageal carcinoma by using pathological method in order toprovide theoretic support for CTV in the realistic working.Method:From December 2003 to May 2004,52 patientsfrom the Forth Hospital of HeBei Medical University undergoneresection whose lesion length is longer than 3cm and proved tobe esophageal squamous cell carcinoma.All surgical resectionspecimens are made into pathologic giant sections.Multicentriccarcinoma lesion(ML),severe dysplasa(SD) and directintramural infiltration(DI) are observed in the large slice bymicroscope.The actural length during the operation is calculatedby the ratio of shrinkage.Blood infiltration and lymphaticinfiltration are also observed by microscope.Patients'computedtomography are imported to 3-dimensional conformalradiotherapy cure planning system,and esophageal lesion isprofiled, and the lesion'volume by digital rebuild program iscomputed. The orderliness of multicentric carcinomalesion,severe dysplasa and direct intramural infiltration areanalysed satistically.Result :1The degree of shrinkage:After resection and ismade into pathologic giant sections,the specimen has asubstantial shrinkage.The upper margins underwent a greaterdegree of shrinkage than the lower margins is reduced to29.69±14% and 44.30±19% of their in-situlengths,respectively.And the tumor is reduced to 89.9±10% oftheir in-situ lengths. The overall shrinkage for the wholespecimen after being made into pathologic giant sections is49.87±9%.252cases a total of 104 slides are studied.Multicentriccarcinoma lesion is found in 15(28.8%)cases,7proximal and3distal to the tumor,5 on both sides.Proximal to the tumor, themean distance between the multicentric carcinogenic lesionand the main lesion plus the length of the mluticentriccarcinogenic lesion(PML) is 3.02±1.45cm(5.0cmmaximum).Distal to the tumor (DML),it is 2.60±2.44cm(7.5cmmaximum).Severe dysplasa is found in28(53.8%)patients,11proximal,11distal and 6 on bothsides.Proximal, the mean distance between the severe dysplasaand the main lesion plus the length of the severe dysplasa(PSD)is 2.45±1.30cm(5.0cm maximum ).Distal to the tumor(DSD) ,itis 3.24±2.19cm(7.5cm maximum).Direct intrumuralinfiltration(DI) is found in 41(78.8%)patients ,12 proximal ,10distal and 19 on both sides.The mean length of direct intramuralinfiltration is 2.80±1.52cm proximally(PDI) (6.4cm maximum)and 2.02±1.51cm distally(DDI)(6.0cm maximum).3Theoccurrence of multicentric carcinoma lesion is statisticallyrelated with lymphatic infiltration . The lymphatic infiltrationpatients's multicentric carcinoma lesion occurrence ratio(38.9%) is much higher than the non-lymphatic infiltrationpatients's(6.3%)(P=0.036); The occurrence of multicentriccarcinoma lesion is not statistically related withsex(P=0.071),type in eye(ulcer,medulla)(P=0.76) ,tumorsite(upper,middle,lower)(P=0.543),N-stage(P=0.614) andTNM-stage(P=0.059). Comparing the case of multicentriccarcinoma lesion and the case of non-multicentric carcinomalesion , tumor length is remarkably different (P=0.039); thetumor depth of the former (2.95±0.53cm) is less than the onesof the latter(3.35±0.59cm), which makes notably difference(P=0.028); the average tumor volume of the former(26.83±11.84cm~3 ) has no statistical difference (P=0.357) withthe one of the latter (33.27±16.37cm3). 4 The mean distancebetween the severe dysplasa and the main tumor plus the lengthof severe dysplasa(SDL) presents negative correlation with themain tumor length, which means the longer the tumor, theshorter of SDL(pearson correlation =-0.385, P=0.043).5Theaverage distance of proximal direct intramural infiltration(PDI)is much longer than the one of distal direct intramuralinfiltration(DDI) ,the difference is statistically significant(P=0.049). The distance of proximal direct intramuralinfiltration(PDI) is positively statistically correlated with tumorlength and depth(P=0.025;P=0.026).Distal doesn't have thefeature(P=0.527;P=0.603). The occurrence of direct intramuralinfiltration(DI) is statistically related with lymphaticinfiltration . The lymphatic infiltration patients's DIoccurrence ratio (86%) is much higher that the non-lymphaticinfiltration patients's(62.5%)(P=0.044);The occurrence of DIis statistically significant with TNM-stage(P=0.05),but not withsex(P=0.564),type in eye(ulcer,medulla)(P=0.734) ,and...