Yoo Ye Jin, Jang Jeong Yun, Kim Sung-Bae, Park Sook Ryun, Kim Yong-Hee, Kim Hyeong Ryul, Kim Jong Hoon
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Kyunghee University Hospital at Gangdong, Seoul, Republic of Korea.
Ann Surg Oncol. 2025 Jun 24. doi: 10.1245/s10434-025-17708-9.
The optimal radiation field for neoadjuvant chemoradiotherapy (NCRT) in patients with esophageal squamous cell carcinoma (ESCC) remains debated. This study investigated recurrence patterns following NCRT with elective nodal irradiation (ENI), specifically comparing the recurrence sites relative with radiation treatment fields.
We retrospectively analyzed 255 patients with ESCC treated with NCRT with ENI. Radiation fields included supraclavicular or celiac lymph nodes on the basis of tumor location. An imaginary involved field irradiation (IFI) was defined to cover the gross tumor with margins. Recurrence sites were classified as within IFI field, between IFI and ENI margins, or outside ENI field.
With a median follow-up of 42.2 months, 65 patients (25.5%) experienced recurrence, and 66.2% of these recurrences occurred with distant metastasis. Among 22 patients with isolated local recurrence (LR), 12 (54.5%) occurred within IFI field and 6 (27.3%) between IFI and ENI margins. The rate of isolated LR between IFI and ENI margins was 0% in upper, 6.2% in middle, and 3.9% in lower thoracic tumors. Among 120 patients with pathologic complete response (pCR), isolated LR occurred in 4 (3.3%), with only 1 case between IFI and ENI margins. In 135 patients with non-pCR, isolated LR was observed in 18 (13.3%), with only 5 between IFI and ENI margins.
Two-thirds of the recurrences occurred with distant metastasis and over half of isolated locoregional recurrences occurred within the IFI field. This highlights the need to reassess extended radiation field and to consider individualized radiation strategies on the basis of tumor location and pathologic response.
食管鳞状细胞癌（ESCC）患者新辅助放化疗（NCRT）的最佳放疗野仍存在争议。本研究调查了接受选择性淋巴结照射（ENI）的NCRT后的复发模式，特别比较了与放疗野相关的复发部位。
我们回顾性分析了255例接受ENI的NCRT治疗的ESCC患者。根据肿瘤位置，放疗野包括锁骨上或腹腔淋巴结。定义一个假想的累及野照射（IFI）以覆盖有边界的大体肿瘤。复发部位分为IFI野内、IFI与ENI边界之间或ENI野外。
中位随访42.2个月，65例患者（25.5%）出现复发，其中66.2%的复发伴有远处转移。在22例孤立性局部复发（LR）患者中，12例（54.5%）发生在IFI野内，6例（27.3%）发生在IFI与ENI边界之间。上胸部肿瘤在IFI与ENI边界之间的孤立性LR发生率为0%，中胸部为6.2%，下胸部为3.9%。在120例病理完全缓解（pCR）患者中，4例（3.3%）出现孤立性LR，仅1例发生在IFI与ENI边界之间。在135例非pCR患者中，18例（13.3%）观察到孤立性LR，仅5例发生在IFI与ENI边界之间。
三分之二的复发伴有远处转移，超过一半的孤立性局部区域复发发生在IFI野内。这突出表明需要重新评估扩大的放疗野，并根据肿瘤位置和病理反应考虑个体化放疗策略。
