Comparison of Efficacy of Regional and Extensive Clinical Target Volumes in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma

Qiao, X.Y.; Wang, Wei; Zhou, Zhen; Gao, Xian; Chang, Joe Y.

doi:10.1016/j.ijrobp.2007.06.031

Cited by 18 publications

(14 citation statements)

References 17 publications

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“…The risk of grade 2 and greater GD toxicities was reported to be between 33% and 80% when combined with chemotherapy in pancreatic cancer [ 11 – 12 , 16 ]. In two retrospective studies for esophageal cancer, the risk of acute toxicity in the upper aerodigestive tract and stomach was 2.3%–11.9% for the small T portal group and 12%–18.6% for the large T portal group [ 8 , 17 ], which was similar to our results. Cosset et al [ 18 ] reported severe late gastric complications included ulcers ( n = 25) and severe gastritis ( n = 2) among 516 patients with Hodgkin's disease treated by RT close to 40 Gy.…”

Section: Discussionsupporting

confidence: 90%

Tolerance and dose-volume relationship of intrathoracic stomach irradiation after esophagectomy for patients with thoracic esophageal squamous cell carcinoma

Liu

Cai

et al. 2015

Oncotarget

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PurposeTo identify the tolerance of radiation with a high prescribed dose and predictors for the development of intrathoracic stomach toxicity in patients with thoracic esophageal squamous cell carcinoma (SCC) after esophagectomy followed by gastric conduit reconstruction.Methods and MaterialsFrom 2011 to 2013, 105 patients after esophagectomy were treated with postoperative radiotherapy. The intrathoracic stomach was outlined with the calculation of a dose-volume histogram (DVH) for the initial intended treatment of 6020 cGy or 6300 cGy. The volume of the intrathoracic stomach receiving each dose was recorded at 10-Gy intervals between 10 and 40 Gy and at 5-Gy intervals between 40 and 60 Gy. The grade of toxicities was defined by the National Cancer Institute Common Toxicity Criteria version 4.0.ResultsThe mean and maximum doses of the intrathoracic stomach were 2449 ± 986 cGy and 6519 ± 406 cGy, respectively. Sixteen (15.2%) and three (2.9%) experienced Common Toxicity Criteria Grade 2 and Grade 3 acute gastric toxicity. There were no Grade 4 toxicities. Fourteen patients (13.3%) exhibited late gastric complications possibly related to radiation. The volume percent of the intrathoracic stomach receiving at least 50 Gy (V50) was strongly associated with the degree of toxicity (p = 0.024, respectively). Multivariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicities.ConclusionsThe intrathoracic stomach is well tolerated with a high-dose irradiation for patients with esophageal SCC receiving radiotherapy after esophagectomy. A strong dose-volume relationship exists for the development of Grade 2 acute intrathoracic stomach toxicity in our study.

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Section: Discussionsupporting

confidence: 90%

Tolerance and dose-volume relationship of intrathoracic stomach irradiation after esophagectomy for patients with thoracic esophageal squamous cell carcinoma

Liu

Cai

et al. 2015

Oncotarget

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“…To date, there are no standards that define an abdominal target area for postoperative radiotherapy, but several options can be recommended. The large T target area includes the supraclavicular draining LNs, mediastinal LN, the anastomosis, and the original esophagus bed [ 1 , 6 , 15 ]; the small T target area includes the supraclavicular draining LNs, upper mediastinal draining LNs, the anastomosis, and the original esophagus bed [ 6 ]; and the conventional target area includes the esophagus bed, the subcarinal LNs, and the left gastric LNs [ 16 ]. However, regardless of the chosen target area, no significant reduction in the rates of abdominal metastasis was observed in cases subjected to postoperative radiotherapy ( P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Patterns and rates of abdominal lymphatic metastasis following esophageal carcinoma

et al. 2017

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AimTo determine the rate of abdominal lymph node metastasis after radical surgery for esophageal cancer and define the radiotherapy target area.MethodsOf the 1593 patients who underwent R0 radical esophagectomy for thoracic esophageal squamous cell carcinoma (TE-SCC), 148 developed abdominal lymph node (LN) metastases within three years of surgery. During that time interval, patients were examined by various imaging methods (enhanced computer tomography, magnetic resonance imaging, and positron emission tomography–CT) at set time points. The emerging recurrence pattern, preferred sites for abdominal metastasis, and correlation with added clinical factors were carefully recorded, to permit for delineation of a target area for radiotherapy.ResultsWe found postoperative metastatic abdominal LNs in 9.3% of the patients treated for esophageal cancer. Lesions in the upper, middle, and lower esophageal segments metastasized to abdominal LNs at 2.3%, 7.8%, and 26.6% (P < 0.0001), respectively. Of all cases, 4.8% had fewer than two affected LNs, while 20.1% had more than three metastatic LNs (P< 0.0001). The metastasis rates of negative and positive celiac LNs were 4.6% and 22.7%, respectively. Abdominal LN metastasis rates for the following LNs: 16a2 and 16a1 of para-aortic, celiac artery, posterior surface of the pancreatic head and common hepatic artery were 64.9%, 41.2%, 37.8%, 32.4%, and 20.9%, respectively. The overall rate of metastasis to these groups of LNs was 91.9%.ConclusionThis study determined that stations 16a1 and 16a2 of the para-aortic, truncus coeliacus, posterior surface of the pancreatic head, and arteria hepatica communis lymph nodes were the preferred sites for abdominal LN metastasis, thus defining target areas for postoperative radiotherapy.

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“…Therefore, the standard CTV of postoperative prophylactic radiotherapy should include the esophageal tumor bed as well as the supraclavicular, mediastinal, and upper abdominal areas. However, the irradiation range differed across various studies that included (1) the bilateral supraclavicular areas and the entire mediastinum [15]; (2) the bilateral supraclavicular areas, the entire mediastinum, and the left gastric lymph nodes [21]; (3) the tumor bed alone [16]; and (4) a T-shaped field including the bilateral lower cervical and supraclavicular areas as well as the upper portion of the mediastinum [7]. Although the issue of which lymph node regions to include in the CTV is controversial, we believe that the patterns of treatment failure after surgery can provide additional guidance in establishing the CTV.…”

Section: Discussionmentioning

confidence: 99%

“…Our data suggest that recurrences in the bilateral supraclavicular areas and the superior mediastinum are more frequent than in other regions and that a CTV consisting of the bilateral supraclavicular and superior mediastinal areas (rather than all lymphatic drainage regions) would be adequate for the vast majority of patients. Qiao et al [21] studied 102 patients who underwent PORT after radical resection for esophageal SCC (T3/4 or N1) and found that the use of a regional portal is not associated with compromised survival rates compared with the use of extensive portal RT. Lu et al [22] retrospectively assessed the survival data of 204 patients and reported that irradiation of the left gastric area is unnecessary after radical surgery when the primary tumor site is in the upper, middle, or middle-upper thirds of the thoracic esophagus; similarly, irradiating the bilateral supraclavicular area is unnecessary when the primary site is in the lower and middle lower thirds.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Failure after Radical Surgery among Patients with Thoracic Esophageal Squamous Cell Carcinoma: Implications for the Clinical Target Volume Design of Postoperative Radiotherapy

Liu

Cai

et al. 2014

PLoS ONE

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BackgroundThis study evaluated patterns of treatment failure (especially locoregional failure; LRF) after radical esophagectomy and proposes a clinical target volume (CTV) for postoperative radiotherapy (PORT) among patients with thoracic esophageal squamous cell carcinoma (SCC).MethodsAll patients who were followed up in our center after radical esophagectomy between 2007 and 2011 were retrospectively enrolled. The patterns of first discovered failure were assessed, and LRFs (including anastomotic and regional lymph node recurrences) were evaluated to determine whether our proposed PORT CTV encompassed these areas. The clinicopathologic factors predictive of lymphatic recurrence type were analyzed.ResultsOf the 414 patients who underwent surgery and were followed up over the study, 207 experienced recurrent or metastatic diseases. The median time to progression was 11.0 months. Of the 173 patients with locoregional recurrence, nodal failure recurred in 160; supraclavicular and superior mediastinal lymph nodes had the highest metastasis rates. All 233 recurrent sites across the 160 patients were located in a standard CTV area, including the bilateral supraclavicular areas, the entire mediastinum, and the left gastric lymphatic drainage region. A total of 203 sites (87.2%) were located in either the bilateral supraclavicular areas or the entire mediastinum, and 185 sites (79.4%) were located in either the bilateral supraclavicular areas or the upper mediastinum. A multivariate analysis revealed the lymph node metastatic ratio (LNMR) and tumor differentiation were risk factors for nodal failure.ConclusionsLocoregional recurrence (especially lymph node recurrence) was the most common and potentially preventable type of initial treatment failure after curative surgery among patients with thoracic esophageal SCC. The proposed PORT CTV covered most LRF sites. The lymphatic drainage regions for PORT are selective, and the supraclavicular and superior mediastinal areas should be considered. However, the value of PORT and the extent of CTV should be investigated in further prospective studies.

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Comparison of Efficacy of Regional and Extensive Clinical Target Volumes in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma

Cited by 18 publications

References 17 publications

Tolerance and dose-volume relationship of intrathoracic stomach irradiation after esophagectomy for patients with thoracic esophageal squamous cell carcinoma

Tolerance and dose-volume relationship of intrathoracic stomach irradiation after esophagectomy for patients with thoracic esophageal squamous cell carcinoma

Patterns and rates of abdominal lymphatic metastasis following esophageal carcinoma

Patterns of Failure after Radical Surgery among Patients with Thoracic Esophageal Squamous Cell Carcinoma: Implications for the Clinical Target Volume Design of Postoperative Radiotherapy

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