Recommendation for the definition of postoperative radiotherapy target volume based on a pooled analysis of patterns of
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RESEARCH
Open Access
Recommendation for the definition of postoperative radiotherapy target volume based on a pooled analysis of patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma Xiaofei Zhang, Xi Yang, Jianjiao Ni, Yida Li, Liqing Zou, Li Chu, Xiao Chu, Fan Xia and Zhengfei Zhu*
Abstract Background: Elective use of radiation therapy to treat regionally involved lymph nodes (LNs) after radical surgery for esophageal squamous cell carcinoma (ESCC) is controversial. We studied metastasis patterns through a pooled analysis of published results to guide post-operative radiotherapy (PORT) target designation. Methods: We searched the MEDLINE database for literature published from May 1977 to March 2018, and found 14 relevant original studies that included 2738 patients with thoracic ESCC. We calculated probabilities of recurrence and metastasis in local (including anastomoses and tumor bed), LNs and distal areas. Results: Recurrence rates were 1.88% for local, 13.18% for distal, and 22.16% for LNs. Within LNs, recurrence rates were cervical/supraclavicular: 37.69%, upper mediastinal: 44.30%, middle mediastinal: 21.81%, lower mediastinal: 2. 57%, abdominal paraaortic: 25% and upper abdominal: 9.56%. Whereas cervical/supraclavicular and upper mediastinal LNs had the highest recurrence rates, abdominal LNs also had high recurrence rates in patients with lower thoracic ESCC. Conclusions: PORT volume should include the cervical/supraclavicular and upper mediastinal LNs for all thoracic ESCC, and abdominal paraaortic LNs for lower thoracic ESCC. Anastomoses and tumor beds should not be included in the PORT volume if they are not adjacent to the PORT-LN regions. Upper abdominal LNs might not necessarily be included in the PORT volume for thoracic ESCC. Keywords: Thoracic esophageal squamous cell carcinoma, Postoperative radiotherapy
Introduction Although incidence rates for esophageal adenocarcinoma have been increasing in several Western countries, esophageal squamous cell carcinoma (ESCC) is the most common histological type in Asian countries, such as China, where it accounts for more than 90% of esophageal carcinoma cases [1]. * Correspondence: [email protected] Department of Radiation Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui, Shanghai 200032, China
Currently, surgery is the mainstay treatment for ESCC, but the overall treatment outcomes have not been satisfactory, with recurrence rates as high as 40–50% after radical surgery [2]. Locoregional recurrence is the most frequent recurrence pattern in ESCC even after definitive lymph node (LN) dissection [3, 4]. Several studies have shown that postoperative radiotherapy (PORT) can improve locoregional control in ESCC patients who undergo surgery [5–7]. However, these studies found no
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International Licens
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