Mapping of Cervical and Upper Mediastinal Lymph Node Recurrence for Guiding Clinical Target Delineation of Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma

Abstract

BackgroundThe lower neck and upper mediastinum are the major regions for postoperative radiotherapy (PORT) in thoracic esophageal squamous cell carcinoma (TESCC). However, there is no uniform standard regarding the delineation of nodal clinical target volume (CTVnd). This study aimed to map the recurrent lymph nodes in the cervical and upper mediastinal regions and explore a reasonable CTVnd for PORT in TESCC.MethodsWe retrospectively reviewed patients in our hospital with first cervical and/or upper mediastinal lymph node recurrence (LNR) after upfront esophagectomy. All of these recurrent lymph nodes were plotted on template computed tomography (CT) images with reference to surrounding structures. The recurrence frequency at different stations was investigated and the anatomic distribution of recurrent lymph nodes was analyzed.ResultsA total of 119 patients with 215 recurrent lymph nodes were identified. There were 47 (39.5%) patients with cervical LNR and 102 (85.7%) patients with upper mediastinal LNR. The high-risk regions were station 101L/R, station 104L/R, station 106recL/R, station 105 and station 106pre for upper TESCC and station 104L/R, station 106recL/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. LNR in the external group of station 104L/R was not common, and LNR was not found in the narrow spaces where the trachea was in close contact with the innominate artery, aortic arch and mediastinal pleura. LNR below the level of the cephalic margin of the superior vena cava was also not common for upper TESCC.ConclusionsThe CTVnd of PORT in the cervical and upper mediastinal regions should cover station 101L/R, station 104L/R, station 106recL/R, station 105 and station 106pre for upper TESCC and station 104L/R, station 106recL/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. Based on our results, we proposed a useful atlas for guiding the delineation of CTVnd in TESCC.

Deep Learning and Registration-Based Mapping for Analyzing the Distribution of Nodal Metastases in Head and Neck Cancer Cohorts: Informing Optimal Radiotherapy Target Volume Design

“…The mapping of nodal metastases and recurrences has a long-standing history in radiation oncology [ 34 ]. However, usually, mapping is performed manually by clinical experts with reference to identifiable anatomic structures [ 35 , 36 , 37 , 38 , 39 , 40 ], which is very time consuming and limits the feasibility of large-scale mapping studies. Therefore, the proposed automated, nonrigid-registration-based mapping method could help in accelerating research into optimal target volume design.…”

Patterns of care and prognostic evaluation for stage I–III upper esophageal squamous cell carcinoma: a population-based study

“…Further, the surgical procedure has many drawbacks for patients with UESCC because of the complexity of anatomical structures in this area and the limitations of the surgery itself. Therefore, radical surgery is usually precluded and associated with high rates of morbidity, mortality (18), and recurrence (19)(20)(21).…”

Comparison of central venous catheter thoracic drainage and traditional closed thoracic drainage following minimally invasive surgery for esophageal carcinoma: a retrospective analysis

“…[ 1 ] the existence of any unstable systemic underlying conditions, such as active infections, history of tuberculosis, uncontrolled hypertension, or unstable angina; [ 2 ] prior history of thoracic surgery; [ 3 ] presence of pneumonia or pulmonary atelectasis as revealed by preoperative chest computed tomography (CT) scans; [ 4 ] impaired coagulation function; [ 5 ] historical usage of anticoagulants; [ 6 ] circumstances wherein, due to unpredictable factors (e.g., substantial hemorrhage, severe pleural adhesions), the surgical procedure necessitates a transition from minimally invasive to open surgery. Our process diagram is depicted in Fig.…”

“…Esophageal carcinoma, a dire and frequently fatal condition, calls for prompt and effective remedial measures [ 1 – 4 ]. Minimally Invasive Surgery (MIS) has ascended as a preferred methodology in the therapeutic landscape of esophageal carcinoma, offering a host of benefits such as mitigated blood loss, truncated hospitalization span, and accelerated recuperation periods [ 5 ].…”