Thoracic Esophageal Squamous Cell Cancer Research Articles

Postoperative Lymph Node Recurrence in Esophageal Cancer After Surgery and Prognosis of Chemoradiotherapy.

This study aimed to evaluate the long-term prognosis of definitive chemoradiotherapy and clinical features of postoperative lymph node (LN) recurrence after curative resection of thoracic esophageal squamous cell cancer (ESCC). A total of 586 patients who underwent radical resection of ESCC at the Hiroshima University Hospital from January 2000 to December 2019 were reviewed retrospectively. This study analyzed the clinical characteristics of 54 patients who developed recurrence in a solitary LN by comparing them to 182 patients who experienced total recurrence. Additionally, we analyzed the prognostic factors of 50 patients who received chemo-radiotherapy (CRT). The results revealed a tendency for a higher incidence of solitary LN recurrence in cases of early esophageal cancer and upper thoracic esophageal cancer among all recurrence cases. The 3-, 5-, and 7-year overall survival (OS) rates were 40.5%, 37.8% and 34.6%, respectively, with a median survival time of 27.9 months. Univariate analysis of OS factors, such as age, depth of the primary tumor at the initial surgery, time to LN recurrence after surgery, site of LN recurrence, and the number of the regional LNs with recurrence showed no significant impact on OS. Approximately 35% of patients with ESCC who experienced LN recurrence after curative resection achieved long-term survival through CRT. Despite the absence of identifiable prognostic factors, CRT proves to be a valuable initial treatment option for LN recurrence.

The Impact of Perioperative Fluid Balance on Postoperative Complications after Esophagectomy for Esophageal Cancer

Background: Perioperative fluid balance is an important indicator in the management of esophageal cancer patients who undergo esophagectomy. However, the association between perioperative fluid balance and postoperative complications after minimally invasive esophagectomy (MIE) remains unclear. Methods: This study included 115 patients with thoracic esophageal squamous cell cancer who underwent MIE between January 2018 and January 2020. We retrospectively evaluated the association between perioperative fluid balance from during surgery to postoperative day (POD) 2, and postoperative complications. Results: The patients were divided into lower group and higher group based on the median fluid balance during surgery and at POD 1 and POD 2. We found that the higher group at POD 1 (≥3000 mL) was the most important indicator of postoperative complications, such as acute pneumonia within 7 days after surgery, and anastomotic leakage (p = 0.029, p = 0.024, respectively). Moreover, the higher group at POD 1 was a significant independent factor for acute postoperative pneumonia by multivariate analysis (OR: 3.270, 95% CI: 1.077–9.929, p = 0.037). Conclusion: This study showed that fluid overload at POD 1 had a negative influence on postoperative complications in patients with esophageal cancer. The fluid balance must be strictly controlled during the early postoperative management of patients undergoing esophageal cancer surgery.

Neoadjuvant chemoradiotherapy combined with perioperative toripalimab in locally advanced esophageal cancer.

e16065 Background: Neoadjuvant chemoradiotherapy (nCRT) followed by surgery has been the standard treatment option for locally advanced esophageal squamous cell cancer (ESCC). However, only 30% to 40% of patients can achieve pathologic complete response (pCR) after nCRT with favorable prognosis. To improve the efficacy of neoadjuvant therapy is an urgent clinical need. Immunotherapy has demonstrated promising results in advanced EC. Among patients received nCRT, PD-1 inhibitor has also provided a benefit as adjuvant treatment. However, the efficacy and safety of PD-1 inhibitor in neoadjuvant treatment still need to be confirmed. The aim of this study was to evaluate the efficacy and safety of the nCRT combined with perioperative toripalimab in locally advanced ESCC. Methods: A prospective, single-armed, exploratory trial was conducted and the key criteria included: resectable thoracic ESCC stage T1-4aN1-2M0 or T3-4aN0M0 according to the 8th edition of the AJCC staging system; aged 18̃75 years old; ECOG PS 0-1. All patients received radiation therapy scheme: 41.4Gy in 23 fractions over 5 weeks, concurrently with 5 cycles of paclitaxel/cisplatin (paclitaxel 45mg/m2 and cisplatin 25 mg/m2) on days 1, 8, 15, 22, 29 and 2 cycles of toripalimab 240 mg every 3 weeks after chemoradiotherapy for neoadjuvant therapy. Esophagectomy is performed 6-8 weeks after CRT completion and after operation patients received 4 cycles of toripalimab 240 mg every 3 weeks for adjuvant treatment. The primary endpoint was major pathological response (MPR: TRG1 and 2) rate. The secondary endpoints were survival outcomes (DFS and OS) and adverse events. Results: A total of 20 patients were enrolled from Jul 2020 to Jan 2022.13 patients have completed surgery in which 10 completed adjuvant immunotherapy, 3 patients have completed neoadjuvant therapy awaiting surgery, and 4 patients are still receiving neoadjuvant chemoradiotherapy. The overall pCR rate was 54% (7/13) and the pCR rate in primary tumor was 62% (8/13). Of the 13 patients, 10 (77%) had MPR (TRG 1 or 2). Treatment-related adverse effects (TRAEs) of any-grade occurred in 13 of 13 (100%) patients and those of grade 3-4 in 7 (54%). The most common any-grade TRAEs were lymphopenia (13/13, 100%), leukopenia (9/13, 69%), esophagitis (6/13, 46%), neutropenia (4/13, 31%) and nausea (3/13, 23%). The grade 3 TRAEs included lymphopenia (7/13, 54%), leukopenia (2/13, 15%), neutropenia (2/13, 15%) and anastomotic fistula (1/13, 8%). Most commonly immune-related adverse events (irAEs) were thyroid dysfunction (2/13, 15%) and pneumonia (1/13, 8%) and all were grade 1̃2. None of these 13 patients had any recurrence within a median follow-up of 6 months after operation. Conclusions: NCRT combined with perioperative toripalimab is feasible and safe for locally advanced resectable ESCC and seems to bring better tumor response. Long-term survival outcomes remain to be determined. Clinical trial information: NCT04437212.

Peritumoral CD16b positive-neutrophil accumulation strongly correlates with regional lymph node metastasis in thoracic esophageal squamous cell cancer

BackgroundThe mechanism underlying cancer cell metastasis from the tumor to regional lymph nodes is not yet fully understood. We hypothesized that peritumoral neutrophil accumulation promotes regional lymph node metastasis in thoracic esophageal squamous cell cancer. MethodsBetween 2010 and 2019, 126 thoracic esophageal squamous cell cancer patients received curative (R0) esophagectomy without preoperative treatment in our hospital. Using paraffin-embedded resected tumors, we performed immunohistochemical analysis of CD16b-positive neutrophil accumulation in the peritumoral area, which was defined as a 1-mm region centered on the border separating the malignant cell nests from the host tissue. The relationship between the density of peritumoral CD16b staining and pathological lymph node metastasis or 5-year overall survival was evaluated. ResultsAlthough the clinicopathological characteristics of CD16b-high and CD16b-low patients did not differ, greater pathological lymph node metastasis (P < .001) and lymphatic invasion by the tumor (P = .024) and a poorer 5-year survival (P = .010) were seen in CD16b-high patients. Moreover, CD16b-positive neutrophil density was generally higher in the peritumoral area than within the tumor itself. Univariate and multivariate analyses showed that CD16b-positive neutrophil accumulation was an independent factor for lymph node metastasis with an odds ratio >25 (P < .001). On the other hand, blood neutrophil counts did not correlate with lymph node metastasis. ConclusionPeritumoral accumulation of CD16b-positive neutrophils is an independent factor strongly correlated with lymph node metastasis in thoracic esophageal squamous cell cancer.

Does synchronous early head and neck cancer with esophageal cancer need treatment after preoperative chemotherapy?

Treatment options for patients with resectable thoracic esophageal squamous cell cancer (ESCC) and synchronous head and neck cancer (HNC) are unclear. Little has been reported about the effects of chemotherapy on early HNC. The aim of this study was to investigate the treatment outcomes of resectable thoracic ESCC with synchronous early HNC. We retrospectively reviewed 37 patients undergoing esophagectomy for thoracic ESCC with synchronous early HNC from January 2008 to December 2018. Among 37 patients who had synchronous early HNC, 27 patients received preoperative therapy for ESCC before HNC treatment, and 16 of 27 patients achieved a complete response for HNC by preoperative chemotherapy. Fifteen of 16 patients did not receive additional treatment, and regional recurrence of HNC was not observed. In one other case, an oral excision was performed, but no cancer cell remnants were found pathologically. No significant difference in overall survival and disease-free survival was observed between 15 patients with follow-up and 22 patients with surgery or radiation. Our results indicate that early HNC with comorbid ESCC could be followed up without additional treatment if preoperative chemotherapy is successful.

Recurrence Risk Stratification Based on Competing-Risks Nomograms to Identify Patients With Esophageal Cancer Who May Benefit From Postoperative Radiotherapy

A reliable model is needed to estimate the risk of postoperative recurrence and the benefits of postoperative radiotherapy (PORT) in patients with thoracic esophageal squamous cell cancer (TESCC).The study retrospectively reviewed 3652 TESCC patients in stage I-III after radical esophagectomy, with or without PORT. In one institution as the training cohort (n = 1620), independent risk factors associated with locoregional recurrence (LRR), identified by the competing risk regression, were used to establish a predicting nomogram, which was validated in an external cohort (n = 1048). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate discrimination. Risk stratification was conducted using a decision tree analysis based on the cumulative point score of the LRR nomogram, and the effect of PORT was evaluated in each risk group.Sex, age, tumor location, tumor grade, and N category were identified as independent risk factors for LRR and added into the nomogram. The AUC values were 0.638 and 0.706 in the training and validation cohorts, respectively. Three risk groups were established. For patients in the intermediate- and high-risk groups, PORT significantly improved the 5-year overall survival by 8.8% and 11.1%, respectively (P < 0.05). Though PORT was significantly associated with reduced LRR in the low-risk group, overall survival was not improved.The nomogram can effectively estimate the individual risk of LRR, and patients in the intermediate- and high-risk groups are highly recommended to undergo PORT.

A phase II study of neoadjuvant immunotherapy combined with chemotherapy (camrelizumab plus albumin paclitaxel and carboplatin) in resectable thoracic esophageal squamous cell cancer (NICE study): Interim results.

4060 Background: We conducted a phase II trial of preoperative chemotherapy with albumin paclitaxel and carboplatin combined with camrelizumab (NICE regimen), in patients with locally advanced esophageal squamous cell carcinoma (ESCC) with multiple lymph nodes metastasis. Initial results were analyzed to assess the efficacy and safety of this strategy. Methods: This was a prospective, multicenter, open, single arm, phase II trial. Eligible patients were histologically confirmed thoracic ESCC, staged as T1b-4a, N2-3 (≥ 3 stations), and M0 or M1 lymph node metastasis (confined to the supraclavicular lymph nodes) according to the 8th edition of American Joint Committee on Cancer. Patients received neoadjuvant treatment (NICE regimen) with intravenous camrelizumab (200 mg, day 1) plus albumin paclitaxel (100 mg/m2, day 1, 8, 15) and carboplatin (area under curve 5, day 1) of each 21-day cycle, for two cycles before surgery. The primary endpoint is pathological complete response (pCR) rate in the per-protocol population, which included all patients who had tumor resection and received at least one cycle of neoadjuvant treatment. Secondary endpoints include R0 resection rate, adverse events and disease-free survival. Safety was assessed in the modified intention-to-treat population. Results: Of the planned 60 patients enrolled, 55 (91.7%) patients have received the full two-cycles NICE regimen successfully, 4 patients didn’t receive the complete neoadjuvant therapy due to intolerance (3 patients) and drop out (1 patient), 1 patient died due to pneumonia on the second cycle of neoadjuvant therapy. Grade 3-5 treatment-related adverse events (TRAEs) rate was 53.3% and TRAEs resulting in discontinuation rate was 6.7%. The common grade 3-5 TRAEs included lymphopenia (50%), thrombocytopenia (10%), pneumonia (5%) and thyroid dysfunction (3.3%). At the time of writing, 47 patients underwent surgery within 27-85 days (median 36 days) after NICE treatment, in which 7 patients had delays to surgery due to TRAEs. All patients achieved radical (R0) resection. There was no in-hospital and postoperative 30-day mortality. pCR (ypT0N0) was identified in 20 (42.5%) of 47 patients and 5 (10.6%) patients had complete pathological response of the primary tumor but residual disease in lymph nodes alone (ypT0N+). Conclusions: Preoperative NICE regimen has achieved satisfatory initial results of disease response in locally advanced thoracic ESCC. A phase III randomized controlled trial is required to demonstarate the possible survival improvement. Trial registration: ChiCTR1900026240 Clinical trial information: ChiCTR1900026240.

Recurrence risk stratification based on a competing-risks nomogram to identify patients with esophageal cancer who may benefit from postoperative radiotherapy.

Background:A reliable model is needed to estimate the risk of postoperative recurrence and the benefits of postoperative radiotherapy (PORT) in patients with thoracic esophageal squamous cell cancer (TESCC).Methods:The study retrospectively reviewed 3652 TESCC patients in stage IB-IVA after radical esophagectomy, with or without PORT. In one institution as the training cohort (n = 1620), independent risk factors associated with locoregional recurrence (LRR), identified by the competing-risks regression, were used to establish a predicting nomogram, which was validated in an external cohort (n = 1048). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate discrimination. Risk stratification was conducted using a decision tree analysis based on the cumulative point score of the LRR nomogram. After balancing the baseline of characteristics between treatment groups by inverse probability of treatment weighting, the effect of PORT was evaluated in each risk group.Results:Sex, age, tumor location, tumor grade, and N category were identified as independent risk factors for LRR and added into the nomogram. The AUC values were 0.638 and 0.706 in the training and validation cohorts, respectively. Three risk groups were established. For patients in the intermediate- and high-risk groups, PORT significantly improved the 5-year overall survival by 10.2% and 9.4%, respectively (p < 0.05). Although PORT was significantly associated with reduced LRR in the low-risk group, overall survival was not improved.Conclusion:The nomogram can effectively estimate the individual risk of LRR, and patients in the intermediate- and high-risk groups are highly recommended to undergo PORT.

127P A prospective phase II clinical trial exploring neoadjuvant immunotherapy combined with chemotherapy in resectable thoracic esophageal squamous cell cancer (TESCC) with multi-station lymph node metastases (NICE study): Preliminary results

127P A prospective phase II clinical trial exploring neoadjuvant immunotherapy combined with chemotherapy in resectable thoracic esophageal squamous cell cancer (TESCC) with multi-station lymph node metastases (NICE study): Preliminary results

Mapping Of Retroperitoneal Lymph Nodal Metastases After Surgery For Lower Thoracic Esophageal Cancer: A Recommendation For Clinical Target Volume

Our previous study showed that retroperitoneal lymph node (RetroLN) metastasis was common in patients with lower thoracic esophageal squamous cell cancer (LTESCC) treated after surgery, indicating a possible benefit of adjuvant radiotherapy in retroperitoneal region. However, little is known about the pattern of RetroLNs failure in LTESCC, which hinders further study. We herein document the site of RetroLNs failure in LTESCC treated after surgery, and propose a delineation for CTV boundaries. LTESCC patients having RetroLNs metastasis after R0 radical esophagectomy in our institution were reviewed. The epicenter of each RetroLN was represented by a circle of 5 mm diameter, and was registered onto corresponding axial CT images of a standard patient, with reference to the surrounding vascular and bony structures. After analyzing the node distribution features, a CTV boundary was proposed, based on which a post-operative RT plan was applied in three simulated cases for safety analysis. A number of 257 RetroLNs from 69 patients were recorded. Twelve patients had solitary RetroLNs metastasis, and 31 patients had RetroLNs failure with distant metastasis. The three most frequent metastasis sites were lateral aortic (48.3%), pre-aortic (22.0%) and intermediate lumber (20.5%). Longitudinally, one LN was higher than the middle level of vertebral T12, and 75.7% of the LNs were seen above the border of 2 cm inferior to the left renal artery, which often near the bottom of vertebral L2. Horizontally, 80% of LNs in celiac level were located within the region confined by the anterior surface of aorta, inferior vena cava (IVC), portal vein, splenic vein and celiac branches. In the superior mesenteric artery (SMA) level, all the LNs except 1 post-aortic LNs were behind the anterior edge of the SMA and anterior to the posterior edge of aorta, 85% were left to the left edge of IVC, and 95% were within 1.5 cm of the left side of the SMA. In the region beneath SMA, 92.7% of LNs appeared right to the lateral edge of the left psoas major (LPM), and all the LNs lied behind the anterior surface of the left renal vein or adjacent to the anterior surface of the aorta, left to the right border of the IVC, and anteriorly to the vertebral and the anterior edge of the LPM. The proposed CTV from the middle level of vertebral T12 to the 2cm below the left renal artery or the bottom of vertebral L2 (depending on which one is lower) with aforementioned boundaries can cover 74.52% of the LNs in the studied group. The post-operative RT treatment plan which included the commonly used T-shield field and the proposed CTV for RetroLNs in three simulated cases all met with satisfactory in the dosimetric analysis. The proposed CTV is the first that focus on the high-risk area of RetroLNs failure in LTESCC patients treated after surgery, and is also feasible in terms of dosimetric performance. The result can serve as a reference for future study to better improve the disease control in LTESCC.

Salvage chemoradiation therapy for recurrence after radical surgery or palliative surgery in esophageal cancer patients: a prospective, multicenter clinical trial protocol

BackgroundCurrently, adjuvant therapy is not recommended for patients with thoracic esophageal squamous cell cancer (TESCC) after radical surgery, and a proportion of these patients go on to develop locoregional recurrence (LRR) within 2 years. Besides, there is no evidence for salvage chemoradiation therapy (CRT) in patients with residual tumor after esophagectomy (R1/R2 resection). In addition, factors like different failure patterns and relationship with normal organs influence the decision for salvage strategy. Here, we aimed to design a modularized salvage CRT strategy for patients without a chance of salvage surgery according to different failure patterns (including R1/R2 resection), and further evaluated its efficacy and safety.MethodsOur study was designed as a one arm, multicenter, prospective clinical trial. All enrolled patients were stratified in a stepwise manner based on the nature of surgery (R0 or R1/2), recurrent lesion diameter, involved regions, and time-to-recurrence, and were further assigned to undergo either elective nodal irradiation or involved field irradiation. Then, radiation technique and dose prescription were modified according to the distance from the recurrent lesion to the thoracic stomach or intestine. Ultimately, four treatment plans were established.DiscussionThis prospective study provided high-level evidence for clinical salvage management in patients with TESCC who developed LRR after radical surgery or those who underwent R1/R2 resection.Trial registrationProspectively Registered. ClinicalTrials.govNCT03731442, Registered November 6, 2018.

Risk Factors and Patterns of Abdominal Lymph Node Recurrence After Radical Surgery for Locally Advanced Thoracic Esophageal Squamous Cell Cancer.

BackgroundWe aimed to identify the suitable indication and delineate the target volume based on the pattern of abdominal lymph node recurrence (ALNR) after radical surgery for guiding postoperative radiotherapy in thoracic esophageal squamous cell cancer (TESCC).MethodsClinical data of patients with locally advanced TESCC after radical surgery without perioperative anti-tumor therapies from June 2011 to June 2016 were reviewed. Logistic regression analysis was used to find out the high-risk factors of ALNR. The pattern of ALNR was analysed and a template CT in the Pinnacle treatment plan system was used to reconstruct the distribution of the sites of ALNR.ResultsA total of 63 (19.57%) patients with 276 lymph nodes of ALNR were identified in 322 patients. Univariate logistic regression indicated that pathological tumor location, width of tumor, T stage, N stage, TNM stage, ratio of lymph node metastasis (LNM), vessel carcinoma embolus, cancerous node, LNM in the middle and lower mediastinum, LNM in the abdominal region, ratio of LNM in the abdominal region were risk factors of ALNR. Multivariate logistic regression analysis showed that only LNM in the abdominal region was an independent risk factor. The odds ratio was 7.449 (95% CI=2.552–22.297, P<0.001). Station 16a2, station 9, station 16b1, and station 8 were the major regions of ALNR. The recurrence rates were 10.56%, 9.63%, 7.14% and 5.28% in these stations, respectively.ConclusionPositive pathological abdominal lymph nodes should be the major indication for abdominal irradiation in postoperative radiotherapy for locally advanced TESCC. We recommended that the target volume includes station 8, station 9, station 16a2 and station 16b1 and proposed a specific delineation of the clinical target volume based on the distribution of ALNR on template CT images.

Adaptive radiotherapy in locally advanced esophageal cancer with atelectasis: a case report

BackgroundTo the best of our knowledge, no study has reported mediastinal shift accompanied with obstructive atelectasis due to bulky primary esophageal tumor components treated with adaptive radiotherapy and concurrent chemotherapy.Case presentationHere we report the case of a 65-year-old male patient diagnosed with locally advanced thoracic esophageal squamous cell cancer, clinical T4bN1M0, stage IVA. Bronchoscopy and computed tomography (CT) revealed an almost complete obstruction of the lumen of the left bronchus due to compression by bulky primary esophageal tumor components. On admission, the patient presented with dyspnea and decreased arterial oxygen saturation. Chest radiography and CT on admission revealed mediastinal shift with left atelectasis, as opposed to findings from the chest radiography performed 26 days before admission. Because of the patient’s overall good condition, we recommended definitive chemoradiotherapy instead of palliative bronchial stent placement. After obtaining the patient’s consent, chemoradiotherapy was initiated on the following day and it comprised three-dimensional conformal radiotherapy with 60 Gy in 30 fractions with concurrent administration of cisplatin and 5-fluorouracil. During chemoradiotherapy, tumor location was monitored with cone-beam CT and chest radiography. Chemoradiotherapy on day 8 revealed no evidence of the mediastinal shift. CT simulation was reperformed to adjust the radiotherapy fields to account for geometrical changes induced by the absence of the mediastinal shift. Subsequently, the mediastinal shift and bronchial obstruction did not recur during the course of chemoradiotherapy. The patient completed the planned radiotherapy with concurrent and adjuvant chemotherapy, and no non-hematological grade ≥ 3 adverse events were observed. Complete response was confirmed 7 months after initiating chemoradiotherapy. Currently, no disease recurrence, dysphagia, or respiratory symptoms have been reported at 13 months after initiating chemoradiotherapy.ConclusionsIn this study, a bulky primary esophageal tumor caused mediastinal shift due to ipsilateral bronchial obstruction. The close follow-up for monitoring resolution of the mediastinal shift during the course of chemoradiotherapy enabled adequate dose delivery to targets, thus reflecting the geometrical changes induced by the absence of the mediastinal shift. Adaptive radiotherapy technique was crucial for favorable patient outcomes in this challenging clinical situation.

Evaluation of surgery plus postoperative radiotherapy or definitive radiotherapy in older patients with thoracic esophageal squamous cell cancer.

This study investigated the outcome of elderly patients (≥65 years) with thoracic esophageal squamous cell carcinoma (TESCC) treated with esophagectomy and postoperative radiotherapy (PORT) or definitive radiotherapy (DRT). One hundred and ninety patients (median age of 72 years) who received PORT (n = 68) or DRT (n = 122) for TESCC were analyzed. Majority of them showed locally advanced disease (T3/4: 70.5%, N+: 70.5%, Stage III: 51.6%). Compared to patients who received DRT, those who received PORT had lower Age-Adjusted Charlson Comorbidity Index (AACCI) scores (2.49 ± 0.61 vs. 3.73 ± 1.28, χ2 = 7.283; P = 0.000) and higher Karnofsky Performance Scale (KPS) (χ2 = 9.016; P = 0.003) and were of younger ages (68.90 ± 3.00 vs. 75.17 ± 5.71, χ2 = 9.925; P = 0.000). Overall survival (OS) was significantly higher in the PORT group (median, 61.2 months; 95% confidence interval [CI], 46.04-76.36) than in the DRT group (median, 24.37 months; 95% CI, 15.43-33.31). Multivariate analysis showed that treatment method (hazard ratio [HR]: 2.38, 95% CI, 1.46-3.90; P = 0.001), clinical T stage (HR: 0.57, 95% CI, 0.34-0.95; P = 0.031), and lymph node metastasis (HR: 0.51, 95% CI, 0.31-0.84; P = 0.008) were independent prognostic factors. Regarding subgroup analysis, OS of patients receiving PORT was significantly higher than that of DRT in the T3-4 group (HR: 2.98, 95% CI, 1.80-4.92; P = 0.000) and the N+ group (HR: 2.20, 95% CI, 1.26-3.83; P = 0.006). The efficacy of PORT for the treatment of elderly TESCC patients was superior to DRT. With regard to AACCI, KPS, and age, DRT is still a treatment option for elderly TESCC patients, especially for those >75 years of age.

A Comparative Study in Assessment of Locoregional Lymph Nodes in Thoracic Esophageal Squamous Cell Cancer: 18f-Alfatide Versus 18f-FDG

A Comparative Study in Assessment of Locoregional Lymph Nodes in Thoracic Esophageal Squamous Cell Cancer: 18f-Alfatide Versus 18f-FDG

Characteristics of the local recurrence pattern after curative resection and values in target region delineation in postoperative radiotherapy for lower thoracic esophageal squamous cell cancer.

BackgroundThe aim of this study was to investigate the patterns and influencing factors of local‐regional recurrence of lower thoracic esophageal squamous cell carcinoma (TESCC) after curative resection and to delineate the clinical target volume (CTV) of postoperative radiotherapy (PORT).MethodsFrom January 2009 to December 2013, the clinical data of patients who experienced local‐regional recurrence after curative esophagectomy were collected and analyzed to determine local‐regional recurrence patterns and to evaluate whether a proposed T‐shaped PORT CTV could cover regions of local‐regional failure.ResultsA total of 108 patients were eligible for this study. All patients experienced postoperative recurrence of lower TESCC. The time to local‐regional failure varied from one to 52 months (average 13.4 ± 11.0). Among the 108 patients, 127 recurrence sites were detected as the first recurrence event: 37 cases in the bilateral supraclavicular region, 56 in the upper mediastinum, 14 in the middle mediastinum, 15 in the upper abdominal lymph nodes, and five cases of anastomotic recurrence. The proposed PORT CTV could successfully cover 89 (82.4%) out of the 108 recurrences and 84.2% of the sites (107/127) of recurrence in our sample.ConclusionLocal‐regional recurrence of lower TESCC is mainly distributed in the supraclavicular, upper‐middle mediastinum, anastomotic stoma, and upper abdominal lymph node regions. The proposed T‐shaped PORT CTV field could cover over 80% of local‐regional failure in our sample; therefore, we suggest that PORT should focus on this area.

Practical Surgical Techniques for Lymphadenectomy Along the Right Recurrent Laryngeal Nerve During Thoracoscopic Esophagectomy in the Prone Position.

In esophageal squamous cell cancer (SCC), lymphadenectomy along the right recurrent laryngeal nerve (RLN) is important for disease control. The metastatic rate was 33% and the 5-year overall survival rate of these patients was 33.3%,1 but the risk of RLN palsy increases.2 We reported a reliable new method ('Pincers Maneuver')3 for lymphadenectomy along the right RLN during thoracoscopic esophagectomy in the prone position (TEP), and hereby present our video, aimed at providing a complete and safe dissection. The 'Pincers Maneuver' is performed for all resectable clinical stage IA-III lower, middle, or upper thoracic esophageal SCCs. Patients above clinical stage IB were treated with neoadjuvant chemotherapy. The concept of this procedure is to first exfoliate the two-dimensional membrane (lateral pedicle), which includes the right RLN, lymph nodes, and the primary esophageal artery, from the right side of the trachea toward the neck. Improved mobility of the lateral pedicle, gained by closing in from its inner and outer sides, enables easy lymphadenectomy along the right RLN toward the right inferior thyroid artery. Using this method, we performed 31 TEPs in 2016 at Kobe University Hospital. Median body mass index was 23kg/m2 (range 18-31). No right RLN palsy greater than Clavien-Dindo classification grade I was observed. On average, 5.2±2.7 nodes were harvested along the right RLN, with a 23% metastatic rate. Our method for lymphadenectomy along the right RLN during TEP is safe and practical. It provides sufficient lymph node dissection, and no right RLN palsy has been observed.

Sphingosine-1-phosphate/sphingosine kinase 1-dependent lymph node metastasis in esophageal squamous cell carcinoma.

To establish whether Sphingosine-1-phosphate (S1P) and sphingosine kinase 1 (SphK1) contribute to lymph node metastasis in esophageal squamous cell carcinoma. Immunohistochemical analysis of SphK1 expression was performed using a tissue microarray containing 177 thoracic squamous cell esophageal cancer specimens resected at surgery, to investigate the association between intratumoral SphK1 expression and lymph node metastasis. Serum S1P levels and intratumoral SphK1 mRNA and protein expression were also evaluated in mice with vs. mice without lymph node metastasis in a murine lymph node metastasis model. Among 177 esophageal cancer patients, 127 (72%) were defined as being SphK1-positive. In univariate and multivariate analyses, SphK1 expression status was a significant factor contributing to lymph node metastasis and poorer 5-year overall survival. In the murine lymph node metastasis model, there was no difference in tumor volume or weight between the lymph node metastasis-negative and lymph node metastasis-positive groups. However, levels of SphK1 mRNA and protein and serum S1P levels were all much higher in the metastasis-positive group. S1P/SphK1 may be novel targets for inhibiting lymph node metastasis in esophageal squamous cell carcinoma, and may provide the basis for a therapeutic strategy to suppress lymph node metastasis.

Which One Is More Reasonable for Concurrent Chemoradiation of Thoracic Esophageal Squamous Cell Cancer, CTV-ENI or CTV-IFI? A Retrospective Study of Basing Postoperative Pathological Data

Which One Is More Reasonable for Concurrent Chemoradiation of Thoracic Esophageal Squamous Cell Cancer, CTV-ENI or CTV-IFI? A Retrospective Study of Basing Postoperative Pathological Data

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

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.