Target Determination of Postoperative Radiotherapy for Thoracic Esophageal Carcinoma Based on the Data of a Prospective Randomized Trial

Abstract

To explore the pattern of lymph node metastases and failure sites of radical resected thoracic esophageal carcinoma (TEC), and to determine the proper target for postoperative radiotherapy. Between Sep. 1986 and Dec. 1997, 549 patients with TEC who had undergone radical resection were randomized into surgery alone (S) group and surgery plus radiotherapy group. Radiotherapy was begun 3-4 weeks after surgery. The irradiation regimen was 50-60 Gy in 25-30 fractions over 5-6 weeks given to the bilateral supraclavicular region and whole mediastinum. The 1-, 3- and 5-year overall survival (OS) rates were 75.1%, 41.2% and 31.5% of patients with either intrathoracic or intraabdominal lymph node metastases, which were higher than 66.3%, 22.5% and 16.3% of those with the both regions involvement. The median survival time was 27 months and 19 months, respectively (p = 0.0132). If only patients with ≥2 positive nodes in S group were selected to eliminate the influence of radiotherapy and positive nodes number, the 5-year OS was 24.8% and 4.9% of patients with node metastases in the one and two regions, respectively (p = 0.0458). For patients with tumors of the upper, mid- and lower thoracic esophagus, the median number of resected nodes was 13, 17 and 20 (p < 0.05), and the rate of para-esophageal node metastases was 61.5%, 65.6% and 64.9% (p > 0.05) in patients with positive nodes. In S group, the failure rate at the mediastinum and supraclavicular region was 26.7% and 16.7% for upper TEC, 29.8% and 14.3% for mid-TEC. The recurrence rate at the anastomosis was 16.7% for upper TEC, which was significant higher than that for mid- and lower TEC (3.1% and 7.7%). For TEC patients who undergo radical resection, the OS is worse for those with more lymph node regions involvement. The rate of para-esophageal node metastases in patients with positive nodes is high regardless of the site of primary tumor. The mediastinum and supraclavicular region for tumors of the upper and mid-thoracic esophagus, as well as the anastomosis for tumors of the upper thoracic esophagus, have high recurrence rate and should be included in radiotherapy.