The local recurrent pattern of middle thoracic esophageal squamous cell carcinoma after left thoracotomy esophagectomy / 中华放射医学与防护杂志

ABSTRACT

Objective To study the local recurrent pattern of postoperative middle thoracic esophageal squamous cell carcinoma( ESCC) and provide the evidence for designing the radiation target in postoperative radiotherapy. Methods From May 2007 to December 2015, a total of 752 patients with local recurrence of postoperative middle thoracic ESCC were included in this retrospective analysis. χ2 test was used to analyze the recurrent pattern of mediastinum, anastomotic, abdominal cavity and primary tumor bed. Results The median interval between surgery and recurrence was 14. 6 months (1-106 months). The highest risk of recurrent site was mediastinum (79. 7%), followed by supraclavicular and anastomotic (29. 1%and 7. 4%, respectively), but rarely occurred at the abdominal cavity and primary tumor bed (4. 1%and 0. 7%, respectively). The relapse rate differed significantly among the five sites (χ2 =925. 8, P<0. 05). Furthermore, the relative metastatic rate in upper mediastinum was 74. 2%, 19. 8%in middle mediastinum and 4. 8%in the lower. There was statistically significant difference in the relative metastatic rate among the three sites(χ2 =791. 6, P <0. 05). Recurrences occurred highly at the 7th, 1st -5th regions, but rarely at 6th, 8th -10th regions. There was significant difference among these 10 regions from the mediastinum(χ2 =486. 9, P<0. 05). The lymphatic metastasis of superior mediastinum was mainly distributed at paratracheal lymph nodes. The metastatic rate of right paratracheal lymph nodes was 47. 1% including 1R,2R and 4R regions and the left paratracheal lymph nodes was 29. 4%including 1L, 2L and 4L regions. The metastatic rate of right supraclavicular paratracheal lymph nodes was significantly higher than that of left ones(χ2 =31. 5, P <0. 05). Conclusions Local recurrence mainly occurred in the bilateral supraclavicular areas, upper/middle mediastinum and anastomosis in patients with middle thoracic ESCC. The bilateral supraclavicular areas, 1st -5th regions of superior mediastinum, 7th region of middle mediastinum and anastomosis should be included in the postoperative prophylactic irradiation target volume.