Abstract
BackgroundElective 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.MethodsWe 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.ResultsRecurrence 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.ConclusionsPORT 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.
Highlights
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].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]
The title and abstract of each retrieved publication were reviewed to confirm that the article reported on the incidence of recurrence patterns, including lymph nodes (LNs) positivity in thoracic ESCC patients after radical surgery
We excluded 1012 studies and selected 14 studies (Fig. 1, Additional file 1: Table S1) [10,11,12,13,14,15,16,17,18,19,20,21,22,23], which included 2738 patients with thoracic ESCC who were treated with radical surgery, and of whom 1643 patients suffered recurrence or metastasis
Summary
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].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 [5,6,7]. Zhang et al Radiation Oncology (2018) 13:255 improved overall survival benefits among their total study cohorts and could support no consensus for the use of PORT in ESCC [8]. 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
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