Pattern of Recurrence in 428 Patients With Thoracic Esophageal Squamous Cell Carcinoma After Radical Surgery and Its Implication in Postoperative Radiotherapeutic Clinical Target Volume.

Tiantian Cui,Wei Huang,Baosheng Li,Qian Zhao,Hongjiao Zhang,Chengxin Liu,Jian Zhu,Yiru Chen,Tao Yu

doi:10.3389/fonc.2021.652365

Abstract

PurposeThis study aimed to analyze the recurrence patterns of thoracic esophageal squamous cell carcinoma (ESCC) after radical surgery, and to understand its implication in the clinical target volume (CTV) design of postoperative radiotherapy (PORT) in patients with ESCC.Methods and materialsA total of 428 recurrent ESCC patients after radical surgery between 2014 and 2018 were included in this study. Recurrence patterns, especially anastomotic and regional lymph node recurrence (LNR), were analyzed. A T-shaped CTV were proposed for PORT and were evaluated whether it could cover most of regional LNR.ResultsThese patients all experienced anastomotic and/or regional LNR. Among the 428 patients, 27 cases (6.3%) had anastomotic recurrence only, and184 cases (43.0%) had LNR only. Those sites with an LNR rate higher than 15% in upper thoracic ESCC were as follows: No.101, No.104R, No.104L, No.106recR, No.106recL, No.106pre, No.106tb, No.107, and No. 109. Those with middle thoracic ESCC were as follows: No.104R, No.104L, 106recR, No.106recL, No.106pre, No.106tb, and No.107. Lastly, individuals with lower thoracic ESCC were as follows: No.104L, 106recR, No.106recL, No. 106pre, No. 106tb, No.107, and abdominal No. 3. The proportion of LNR not included in the proposed T-shaped CTV was 12.5% (1/8), 4.7% (6/128), and 10.4% (5/48) in the upper, middle, and lower thoracic segments, respectively.ConclusionsLNR was the most common type of local-regional recurrence in patients after radical surgery. Supraclavicular, superior and middle mediastinal lymph nodes had the highest recurrence rate, the rate of LNR which was outside T-shaped PORT CTV we proposed was less than 15%.

Highlights

Esophageal cancer, especially esophageal squamous cell carcinoma (ESCC), has a high incidence rate in China and East Asia
The proportion of lymph node recurrence (LNR) not included in the proposed T-shaped clinical target volume (CTV) was 12.5% (1/8), 4.7% (6/128), and 10.4% (5/48) in the upper, middle, and lower thoracic segments, respectively
Supraclavicular, superior and middle mediastinal lymph nodes had Recurrence of TESCC After Operation the highest recurrence rate, the rate of LNR which was outside T-shaped postoperative radiotherapy (PORT) CTV we proposed was less than 15%

Summary

Introduction

Esophageal cancer, especially esophageal squamous cell carcinoma (ESCC), has a high incidence rate in China and East Asia. According to a previous study, 90% of esophageal cancer patients are diagnosed with ESCC in China [1]. For patients with thoracic ESCC, esophagostomy is a highly effective treatment. The recurrence rate of ESCC after radical surgery ranges as high as 40–50% [2], with locoregional recurrence being the major cause of treatment failure [3, 4]. Previous studies have shown that postoperative radiotherapy (PORT) after performing a radical resection of esophageal cancer can reduce the local recurrence rate [5]. The clinical target volume (CTV) for PORT on thoracic ESCC patients is still controversial

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