Clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma and modification of target volume
10.3760/cma.j.issn.1004-4221.2016.04.007
- VernacularTitle:胸中段淋巴结阳性食管癌术后放疗的临床意义
- Author:
Shufei YU
;
Wencheng ZHANG
;
Zefen XUAO
;
Zongmei ZHOU
;
Hongxing ZHANG
;
Dongfu CHEN
;
Qinfu FENG
;
Jun LIANG
;
Jima LYU
;
Jie HE
;
Shugeng GAO
;
Qi XUE
;
Yongsheng MAO
;
Kelin SUN
;
Xiangyang LIU
;
Guiyu CHENG
;
Dekang FANG
;
Jian LI
- Publication Type:Journal Article
- Keywords:
Eesophageal neoplasms/postoperative radiotherapy;
Radiotherapy,intensity-modulated;
Prognosis
- From:
Chinese Journal of Radiation Oncology
2016;25(4):332-338
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma ( TESCC ) and to modify the target volume .Methods A total of 286 patients with node-positive middle TESCC underwent radical surgery in Cancer Hospital, Chinese Academy of Medical Sciences, from 2004 to 2009.In addition, 90 of these patients received postoperative intensity-modulated radiotherapy.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis.The Cox model was used for multivariate prognostic analysis.The chi-square test was used for comparing the recurrence between patients receiving different treatment modalities.Results The 5-year overall survival ( OS) rates of the surgery alone ( S) group and surgery plus postoperative radiotherapy ( S+R) group were 22.9%and 37.8%, respectively, and the median OS times were 23.2 and 34.7 months, respectively ( P=0.003) .For patients with 1 or 2 lymph
node metastases (LNMs), the 5-year OS rates of the S group and S+R group were 27.3%and 44.8%, respectively ( P=0.017);for patients with more than 2 LNMs, the 5-year OS rates of the S group and S+R group were 16.7%and 25.0%, respectively (P=0.043).The peritoneal lymph node metastasis rates of N1 , N2 , and N3 patients in the S group were 2.9%, 10.9%, and 20.0%, respectively ( P=0.024) .The S+R group had a significantly lower mediastinal lymph node metastasis rate than the S group ( for patients with 1 or 2 LMNs:8.0%vs.35.3%, P=0.003;for patients with more than 2 LNMs, 10.0%vs.42.3%, P=0.001) , and had a prolonged recurrence time compared with the S group ( 25.1 vs.10.7 months, P=0.000) .However, for patients with more than 2 LNMs, the S+R group had a significantly higher hematogenous metastasis rate than the S group (46.7%vs.26.1%, P=0.039).Conclusions Patients with node-positive middle TESCC could benefit from postoperative radiotherapy.The target volume can be reduced for patients with 1 or 2 LNMs.Prospective studies are needed to examine whether it is more appropriate to reduce the radiotherapy dose than to reduce the target volume for patients with more than 2 LNMs.A high hematogenous metastasis rate warrants chemotherapy as an additional regimen.
