Gao Xian-Shu, Qiao Xueying, Wu Fengpeng, Cao Li, Meng Xianli, Dong Zhiming, Wang Xiaoling, Gao Guodong, Wu Tsung-Teh, Komaki Ritsuko, Chang Joe Y
Department of Radiation Oncology, Beijing University First Hospital, Beijing, P R China.
Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):389-96. doi: 10.1016/j.ijrobp.2006.09.015.
To clarify the radiotherapy clinical target volume (CTV) margin needed for esophageal squamous-cell carcinoma (SCC) and gastroesophageal junction (GEJ) adenocarcinoma.
Surgical specimens of esophageal SCC (n = 34) and GEJ adenocarcinoma (n = 32) were prospectively collected and analyzed for microscopic spread along the esophagus and GEJ both proximally and distally from gross tumor and for lymph node (LN) metastasis.
For SCC, the mean microscopic spread beyond the gross tumor was 10.5 +/- 13.5 mm proximally (<30 mm in 32 of 34 cases) and 10.6 +/- 8.1 mm distally (<30 mm in 33 of 34 cases). For GEJ adenocarcinoma, the spread was 10.3 +/- 7.2 mm proximally (<30 mm in 29 of 29 cases) and 18.3 +/- 16.3 mm distally (<30 mm in 27 of 32 cases). The extent of microscopic spread of cancer was significantly associated with pathologic T stage (p = 0.012). LN metastases were observed in 12 (35%) of 34 patients with middle and lower esophageal SCC and 15 (47%) of 32 patients with GEJ adenocarcinoma.
The extent of microscopic spread within esophagus (recommended CTV margin) was <30 mm in about 94% of cases of esophageal cancer, except for distal microscopic spread in GEJ adenocarcinoma, in which 50 mm was needed to cover about 94% of cases.
明确食管鳞状细胞癌（SCC）和胃食管交界（GEJ）腺癌所需的放射治疗临床靶区（CTV）边界。
前瞻性收集并分析了34例食管SCC和32例GEJ腺癌的手术标本，以观察肿瘤大体边缘近端和远端沿食管及GEJ的微观扩散情况以及淋巴结（LN）转移情况。
对于SCC，肿瘤大体边缘近端的平均微观扩散为10.5±13.5 mm（34例中有32例<30 mm），远端为10.6±8.1 mm（34例中有33例<30 mm）。对于GEJ腺癌，近端扩散为10.3±7.2 mm（29例中有29例<30 mm），远端为18.3±16.3 mm（32例中有27例<30 mm）。癌症的微观扩散范围与病理T分期显著相关（p = 0.012）。在34例食管中下段SCC患者中有12例（35%）观察到LN转移，在32例GEJ腺癌患者中有15例（47%）观察到LN转移。
除GEJ腺癌的远端微观扩散需要50 mm以覆盖约94%的病例外，食管癌约94%的病例中食管内微观扩散范围（推荐的CTV边界）<30 mm。
