Determination of radiotherapeutic target zones for thoracic esophageal squamous cellcancer with lower cervical lymph node metastasis according to CT-images.

Xingde Li,Yue Zhao,Fushan Zhai,Lijie Han,Mingyun Zhang,Haiyan Wang,Zhengfei Zhu,Feng Yu,Ming Liu,Jin Zhao

doi:10.18632/oncotarget.9094

Abstract

Esophageal squamous cell carcinoma (ESCC) is a leading cause of cancer-related deaths worldwide. And radical synchronized chemoradiotherapy has become an important treatment measures for this disease. It is necessary to define the therapeutic target zone based on computer tomography(CT)-images for precise radiotherapy. Therefore, we retrospectively analyzed the regularity of lymph node metastasis in lower cervical section of thoracic esophageal cancer based on CT-images and discussed the range of radiotherapy in supraclavicular zone. The lower cervical lymphatic drainage area was divided into cervical tracheoesophageal groove (CTG), medial supraclavicular zone (MSC zone) and lateral supraclavicular zone (LSC zone) based on CT-images. We found that the rate of lymph node metastasis to medial CTG and MSC zone was relatively high. And rate of lymph node metastasis to the above two zones from middle thoracic section was on an increasing trend with the progress of T stage. Patients at stage T3 and T4 with lymph node metastasis in tracheoesophageal groove in middle thoracic section showed a higher rate of lymph node metastasis in MSC zone. These results demonstrated that the CTG and MSC zone should be clinically included in the supraclavicular target zone for radical radiotherapy, and the T-stage and tumor location should be considered simultaneously.

Highlights

Esophageal cancer continues to be one of the most common malignancies worldwide [1] as well as the third most common gastrointestinal malignancy
We retrospectively analyzed the regularity of lymph node metastasis in lower cervical section of thoracic esophageal cancer based on CT-images and discussed the range of radiotherapy in supraclavicular zone
As we have concluded that the rate of lymph node metastasis to cervical tracheoesophageal groove (CTG) and MSC zone from middle thoracic section of esophageal cancer was on an increasing trend with the progress of T stages, we further explored the relationship between the lymph node metastasis in lower CTG and MSC zone at different T stages in middle thoracic section

Summary

Introduction

Esophageal cancer continues to be one of the most common malignancies worldwide [1] as well as the third most common gastrointestinal malignancy. Squamous cell carcinoma (SCC) is still the predominant form of the disease. The main causes of treatment failure for this disease are local uncontrol and distant metastasis. Some researchers have found that the 5-year survival rate of chemoradiation for esophageal cancer is close to surgery [2,3]. Radical synchronized chemoradiotherapy has become an important treatment measures for esophageal cancer [4]. There is no consensus about the determination of radiotherapeutic target zones for esophageal cancer, especially it is of great controversy at present whether the selective lymph node irradiation (ENI) is needed for radical radiotherapy [5, 6]

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Results

Conclusion