Do We Need to Add Postoperative Radiotherapy in Patients Undergoing Trimodality Therapy for Esophageal Squamous Cell Carcinoma with Positive Lymph Nodes Disease?

2017 ◽  
Vol 35 (2) ◽  
pp. 104-110 ◽  
Author(s):  
Pei-Ming Huang ◽  
Feng-Ming Hsu ◽  
Chia-Chi Lin ◽  
Chin-Hung Hsu ◽  
Jason Chia-Hsien Cheng ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Postoperative Radiotherapy ◽  
Trimodality Therapy ◽  
Positive Lymph Nodes

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

2021 ◽  
Vol 11 ◽  
Author(s):  
Yichun Wang ◽  
Dongmei Ye ◽  
Mei Kang ◽  
Liyang Zhu ◽  
Mingwei Yang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Mediastinal Lymph Node ◽  
Postoperative Radiotherapy ◽  
Vena Cava ◽  
Lymph Node Recurrence

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.

scholarly journals The Prognosis and Feasibility of Extensive Clinical Target Volume in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma: A Phase II Clinical Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaofei Zhang ◽  
Dashan Ai ◽  
Juanqi Wang ◽  
Yun Chen ◽  
Qi Liu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Postoperative Radiotherapy ◽  
Locally Advanced ◽  
Target Volume ◽  
Local Control Rate

BackgroundThis trial aims to explore the feasibility and safety of postoperative radiotherapy covering all regional lymph node areas for locally advanced thoracic esophageal squamous cell carcinoma patients treated with intensity-modulated radiation therapy (IMRT).MethodsThis was a single-center single-arm, phase II clinical trial initiated in 2014. Patients who were treated with radical transthoracic resection and had negative margins within 3 months and histologically confirmed esophageal squamous cell carcinoma (pT3-4 or N+, M0 determined by the 7th edition of the AJCC guidelines) were recruited in this trial. Postoperative radiotherapy was performed with a total dose of 40 Gy in 20 fractions using IMRT. Clinical target volumes (CTVs) included the tumor bed, anastomosis, bilateral supraclavicular region, mediastinal lymph nodes, left gastric lymph nodes and celiac trunk lymph nodes. The primary endpoint was the 2-year local control rate, and the secondary endpoints were overall survival (OS) and adverse events (AEs).ResultsA total of 70 eligible patients were recruited from 2014 to 2016. The 2-year local control rate, as the primary endpoint, was 67.3%. In addition, the median OS was 57.0 months, with 1-year and 3-year OS rates of 92.8% and 60.9%, respectively. Among the patients, 28/40 (40%) developed locoregional recurrence, with 25.7% involving hematogenous recurrences. All reported AEs occurred during the course of IMRT or within 6 months thereafter. None of them suffered grade 4 hematological or nonhematological AEs. Nearly all patients completed the entire course of postoperative radiotherapy, with a completion rate of 97.1%.ConclusionFor an extensive target volume, 40 Gy is feasible and shows acceptable toxicity in patients with locally advanced thoracic esophageal squamous cell carcinoma, although the local recurrence rate is relatively high. Our findings provide a basis for further exploration of high-dose radiation with extensive CTV combined with chemotherapy.Clinical Trial Registration[http://www.clinicaltrials.gov/ct2/results?cond=&term=NCT02384811&cntry=&state=&city=&dist=], identifier [NCT02384811].

scholarly journals Comprehensive analysis of prognostic value of lymph node classifications in esophageal squamous cell carcinoma: a large real-world multicenter study

2021 ◽  
Vol 13 ◽  
pp. 175883592110548
Author(s):  
Junmiao Wen ◽  
Jiayan Chen ◽  
Donglai Chen ◽  
Salma K. Jabbour ◽  
Tao Xue ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Predictive Accuracy ◽  
Seer Database ◽  
Risk Of Death ◽  
Positive Lymph Nodes

Background: We aim to assess the prognostic ability of three common lymph node–based staging algorithms, namely, the number of positive lymph nodes (pN), the lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in patients with esophageal squamous cell carcinoma (ESCC). Methods: A total of 3902 ESCC patients treated at 10 Chinese institutions between 2003 and 2013 were included, along with 2465 patients from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic ability of the aforementioned algorithms was evaluated using time-dependent receiver operating characteristic (tdROC) curves, R2, Harrell’s concordance index (C-index), and the likelihood ratio chi-square score. The primary outcomes included cancer-specific survival (CSS), overall survival (OS), and CSS with a competing risk of death by non-ESCC causes. Results: LODDS had better prognostic performance than pN or LNR in both continuous and stratified patterns. In the multicenter cohort, the multivariate analysis showed that the model based on LODDS classification was superior to the others in predictive accuracy and discriminatory capacity. Two nomograms integrating LODDS classification and other clinicopathological risk factors associated with OS as well as cancer-specific mortality were constructed and validated in the SEER database. Finally, a novel TNLODDS classification which incorporates the LODDS classification was built and categorized patients in to three new stages. Conclusion: Among the three lymph node–based staging algorithms, LODDS demonstrated the highest discriminative capacity and prognostic accuracy for ESCC patients. The nomograms and novel TNLODDS classification based on LODDS classification could serve as precise evaluation tools to assist clinicians in estimating the survival time of individual patients and improving clinical outcomes postoperatively in the future.

scholarly journals Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes

Oncotarget ◽  
2015 ◽  
Vol 6 (34) ◽  
pp. 36911-36922 ◽  
Author(s):  
San-Gang Wu ◽  
Jia-Yuan Sun ◽  
Li-Chao Yang ◽  
Juan Zhou ◽  
Feng-Yan Li ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Log Odds ◽  
Positive Lymph Nodes

scholarly journals Mapping patterns of metastatic lymph nodes for postoperative radiotherapy in thoracic esophageal squamous cell carcinoma: a recommendation for clinical target volume definition

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jing Yu ◽  
Wen Ouyang ◽  
Chunyang Li ◽  
Jiuling Shen ◽  
Yu Xu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Clinical Target Volume ◽  
Postoperative Radiotherapy ◽  
Target Volume ◽  
Thoracic Esophagus ◽  
Axial Ct

Abstract Background The clinical target volume (CTV) for postoperative radiotherapy for thoracic esophageal squamous cell carcinoma (TESCC) needs to be defined. The study aim was to map metastatic lymph nodes (LNMs) in a computed tomography (CT)-based atlas and delineate the postoperative radiotherapy target area. Methods Sixty-nine TESCC patients with first recurrent regional LNMs after esophagectomy were included. The LNM epicenters were registered onto corresponding anatomic axial CT images of a standard patient in the treatment position, with reference to the surrounding vascular and bony structures. The LNM sites were based on lymph node map of esophageal cancer, AJCC 8th. The lymph metastasis risk for different segments of thoracic esophagus was assessed. Results One hundred and seventy-nine LNMs were mapped onto standard axial CT images. The upper-middle mediastinum region (station 1 to 8 M) contained 97% of metastases in the upper segment of thoracic esophagus, 90% in the middle segment, and 66% in the lower one. Advanced pathological stage (≥IIIB) might be a predictive factor for upper abdominal region (UAR) relapse in lower TESCC. Lower cervical para-tracheal LNMs were within a 4.3-cm bilaterally expanded area from the midline of the body and a 2.2-cm expanded area from the anterior of vertebral body, from the superior border of the C7, to the inferior border of the first thoracic vertebra. Conclusion A modified target from the upper border of C7 to the lower border of caudal margin of the inferior pulmonary vein level could cover the high-risk area of TESCC underwent postoperative radiotherapy. UAR seems to be an elective irradiation target for lower TESCC at pathological IIIB stage and higher.

163 TRANSHITAL ESOPHAGECTOMY IN THE TREATMENT OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
C Kruel ◽  
F Vieira ◽  
R Schramm ◽  
M Chedid ◽  
A Rosa ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Neoadjuvant Therapy ◽  
Squamous Cell ◽  
Transhiatal Esophagectomy ◽  
Postoperative Treatment ◽  
Surgical Time ◽  
Positive Lymph Nodes

Abstract   In the state of Rio Grande do Sul, Brazil, it is encountered a very high incidence of. esophageal squamous cell carcinoma in the world.(1). Advances in surgical procedure techniques and. postoperative treatment have arisen in esophagectomy, which remains as with significant morbidity. and mortality. Compared to other esophagectomies. conducted with thoracotomy, such as Ivor-Lewis and McKeown techniques, the Transhiatal. esophagectomy has a shorter surgical time, a lower rate of mediastinitis and then lower morbidity. Methods Ninety-six patients undergoing transhiatal esophagectomy in the Hospital de Clínicas de Porto Alegre, between 2005 and 2017 were evaluated. Thirteen patients underwent neoadjuvant treatment with chemoradiotherapy. Ninety-day survival and 5-year survival were evaluated. Results Overall 90-day survival was 91.7%. The overall 5-year survival was 41.2%. Patients undergoing neoadjuvant therapy had a 90-day survival of 100% and a 5-year survival of 74.1%. Patients undergoing frontline esophagectomy had a 90-day survival of 90.3% and 5-year survival rate of 36%. Non-neoadjuvant patients with negative lymph nodes had a 5-year survival of 50.2%. The average surgical time was 253 minutes. Thirty-seven patients (38.5%) had positive lymph nodes in the surgical specimen. Multivariate analysis showed that surgical time and presence of positive lymph nodes are associated with a worse outcome. Conclusion Patients submitted to transhiatal esophagectomy present considerable long-term survival, which can be amplified in the absence of lymph node involvement. Operated patients who have undergone neoadjuvant therapy prior to surgery demonstrate increased survival times compared with those without treatment. References 1) Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol. 2001 Dec;30(6):1415–25.

scholarly journals Comparison of three lymph node staging systems in evaluating the prognosis of patients with pT3 esophageal squamous cell carcinoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Di-tian Liu ◽  
Lin-shuo Wang ◽  
Yu-ping Chen ◽  
Shao-bin Chen
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Staging System ◽  
Lymph Node Staging ◽  
Staging Systems ◽  
Positive Lymph Nodes

Abstract To explore the prognostic value of three lymph node staging systems, including number of positive lymph nodes (pN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS), in patients with pT3 stage esophageal squamous cell carcinoma (ESCC). Data from 1667 patients with pT3 stage ESCC who underwent surgical resection were reviewed. The log-rank test was used to assess the differences in overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors. The receiver operating characteristic curve was used to assess the prognostic accuracy of the three staging methods. The median survival time for the entire group was 48.0 months, and the 1-, 3- and 5-year OS rates were 83.9%, 55.1% and 66.6%, respectively. All three lymph node staging systems were significantly correlated with OS in univariate and multivariate analyses. However, LNR and LODDS staging systems could more accurately predict survival than the pN staging system in patients with < 15 lymph nodes dissected, while LODDS have the best prognostic homogeneity. All three staging systems could be used for prognostic assessment in pT3 stage ESCC. But LODDS staging system might be superior to the others due to its prognostic homogeneity.

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