Abstract
BackgroundChemoradiotherapy (CRT) is an effective modality for stage I esophageal squamous cell carcinoma (ESCC). However, salvage treatments are often required even if complete response (CR) has been achieved. To this end, it is important to accurately diagnose lymph node or other organ metastatic recurrences. Note that lymph node enlargements (except metastatic recurrence) are often detected during the follow-up period after CRT. The purpose of this study was to elucidate the clinical characteristics of lymph node enlargement after CRT.MethodsIn this retrospective cohort study, patients diagnosed with stage I (T1 [submucosal invasion] N0M0) ESCC were treated with cisplatin and 5-fluorouracil concurrently with radiotherapy. A total of 55 patients were enrolled in the study from February 2006 to August 2011.ResultsThe median follow-up period was 46 months. The 3-year overall and progression-free survival rates were 90.7% and 71.2%, respectively, and the CR rate was 87.2% (48/55). Nine of the 48 CR patients were finally diagnosed with recurrences, including 7 lymph node metastases and 2 local recurrences. Lymph node enlargement was initially identified in 20 of the total 55 patients during the follow-up; 9 patients were finally diagnosed with lymph node recurrence, whereas 11 patients had benign reactive lymph node enlargement.ConclusionThe present study demonstrated the high incidence of enlarged lymph nodes after CRT for stage I ESCC. It is important to accurately distinguish between benign lymph node enlargement and recurrent lymph nodes to avoid unnecessary salvage treatments.
Highlights
Chemoradiotherapy (CRT) is an effective modality for stage I esophageal squamous cell carcinoma (ESCC)
5 patients had been treated for malignancies in other organs, which were inactive when CRT was performed for ESCC
During the follow-up period, the second primary cancers in the other organs were observed in 10 patients: pancreas, skin, and prostate, 1; biliary duct, 1; urinary tract, 1; pharynx, 1; colon, 1; lung and stomach, 1; vocal cord and stomach, 1; valve, 1; thyroid, 1; and stomach, 1
Summary
Chemoradiotherapy (CRT) is an effective modality for stage I esophageal squamous cell carcinoma (ESCC). Salvage treatments are often required even if complete response (CR) has been achieved To this end, it is important to accurately diagnose lymph node or other organ metastatic recurrences. The purpose of this study was to elucidate the clinical characteristics of lymph node enlargement after CRT. Surgical esophagectomy with lymphadenectomy is considered to be the standard treatment for patients in clinical stages I to III ESCC [2,3]. CRT is considered to be less invasive because of the better quality of life after the treatment compared to esophagectomy. A phase II study has demonstrated that definitive CRT is a favorable alternative to esophagectomy in patients with clinical stage I ESCC [10,12]
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