Pattern of lymph nade metastasis in determining the indication and target of post-operative prophylactic radiotherapy for thoracic esophageal carcinom / 中华放射肿瘤学杂志

ABSTRACT

Objective To study the pattern of lymphatic metastasis in patients with thoracic esopha-geal carcinoma, and to determine the indication and the target volume for post-operative radiotherapy. Meth-ods 229 patients with thoracic esophageal carcinoma who had undergone radical esophagectomy and two-field lymph node dissection were included in this study. The pattern and ratio of lymph node metastasis were analyzed. The effect of the tumor length and pathology stage on lymph node metastasis was studied. Then the indication and target of post-operative radiotherapy for the thoracic esophageal carcinoma was determined. Results Regional lymph node metastasis was found in 57.1% patients with upper thoracic esophageal car-cinoma. For the middle thoracic esophageal carcinoma, the ratio of regional metastasis, skip, upward, down-ward and two-way spread were 39.0%, 19.5% ,5.2% ,28.6% and 7.8% ,respectively. For lower thoracic esophageal carcinoma,downward spread was found in 77.2% patients. For upper thoracie esophageal carci-noma,the proportions of patients with lymph node metastasis were 19.0% ,6.7% ,9.8% and 14.3% in the superior mediastinum, middle mediastinum, inferior mediastinum and abdominal cavity ( x2 = 2.75, P = 0.433). The corresponding figures were 26.1% ,7.4% ,11.8% and 11.9% (x2 = 17.98,P =0.000) for middle thoracic esophageal carcinoma,and 0%, 1.6% ,5.3% and 10.0% (x2= 5.96 ,P = 0. 051 ) for low-er thoracic esophageal carcinoma. The lymph node metastasis ratios were 9.1%, 11.6% and 11.7% in pa-tients with tumor ≤3 cm,3-5 cm and ≥5 cm,respectively (x2 =3.93,P=0. 140), and were much higher in stage Ⅲ disease than those in stage 0 to Ⅱ (19.3% vs4.8% ;x2 =131.06,P=0.000). Conclusions he pattern of lymph node metastasis is complex and extensive in patients with thoracic esophageal carcinoma. For upper and middle thoracic esophageal carcinoma, the extended prophylactic portal is suggested and the superior mediastinum is an important target area. For the lower thoracic esophageal carcinoma,it seems that regional fields could be applied. Post-operative radiotherapy should be performed in stage Ⅲ disease because of the high lymph node metastasis ratio.