Wang Y X, Yang Q, He M, Qiu R, Li J, Zhu S C, Qiao X Y, Qi Z
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China (Present affiliation: Department of Radiation Oncology, Handan Central Hospital, Hebei Province, China).
Zhonghua Zhong Liu Za Zhi. 2017 Jan 23;39(1):48-55. doi: 10.3760/cma.j.issn.0253-3766.2017.01.010.
To evaluate the patterns of recurrence and their value on target delineation for postoperative radiotherapy (RT) in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy. 395 patients (302 male and 93 female) of stage Ⅲ thoracic ESCC after radical resection were enrolled in this study. Among them, 375 patients were treated with two-field and other 20 with three-field esopahgectomy. 97 patients were treated with surgery alone, 212 with adjuvant postoperative chemotherapy (CT), 56 with radiotherapy (RT) and 30 with CT plus RT. Diagnosis of recurrence was primarily based on CT images, some of which were biopsy confirmed. The location and patterns of tumor recurrence were analyzed. The overall failure rates was 75.7% (299/395). Locoregional recurrence (LR) was found in 48.4% of the patients, distant metastasis (DM) in 16.2%, and LR plus DM in 4.3%. There were 208 patients occurred with LR, 26.9% (56) recurred in supraclavicular/neck (51 in supraclavicular), 69.7% (145) in mediastinum (88.7% in upper-mediastinum), and 19.7% (41) in upper abdomen (38 in para-aortic lymph node). Chi-square test and logistic multivariate regression analysis showed that TNM stage and adjuvant therapy were significantly associated with LR (<0.05). Postoperative RT reduced LR (mainly LR in mediastinum), but postoperative CT did not decrease LR. The recurrence rate is very high in stage Ⅲ thoracic ESCC patients, LR is the main pattern of failure. TNM stage is one of the most important factors for LR. Postoperative radiotherapy can reduce LR but postoperative chemotherapy does not decrease LR. Upper-mediastinum is the most common site of recurrence, followed by supraclavicular and para-aortic regions; these areas should be considered as the key target of postoperative radiotherapy.
评估Ⅲ期胸段食管鳞状细胞癌（ESCC）患者食管切除术后复发模式及其在术后放疗（RT）靶区勾画中的价值。本研究纳入了395例Ⅲ期胸段ESCC患者，这些患者均接受了根治性切除，其中男性302例，女性93例。其中，375例行两野食管切除术，20例行三野食管切除术。97例仅接受手术治疗，212例接受术后辅助化疗（CT），56例接受放疗（RT），30例接受CT联合RT。复发的诊断主要基于CT图像，部分经活检证实。分析肿瘤复发的部位和模式。总失败率为75.7%（299/395）。48.4%的患者出现局部区域复发（LR），16.2%出现远处转移（DM），4.3%出现LR加DM。有208例患者发生LR，26.9%（56例）在锁骨上/颈部复发（51例在锁骨上），69.7%（145例）在纵隔复发（88.7%在上纵隔），19.7%（41例）在上腹部复发（38例在主动脉旁淋巴结）。卡方检验和逻辑多因素回归分析显示，TNM分期和辅助治疗与LR显著相关（<0.05）。术后放疗可降低LR（主要是纵隔LR），但术后化疗不能降低LR。Ⅲ期胸段ESCC患者复发率很高，LR是主要的失败模式。TNM分期是LR的最重要因素之一。术后放疗可降低LR，但术后化疗不能降低LR。上纵隔是最常见的复发部位，其次是锁骨上和主动脉旁区域；这些区域应被视为术后放疗的关键靶区。
