胸段食管癌术后局部复发因素在确定术后放射治疗指征及放疗靶区中的价值

目的:探讨胸段食管癌术后局部复发因素对确定术后放疗指征及术后放疗靶区的指导意义.方法:回顾性分析2009年1月-2011年6月75例胸段食管癌术后局部复发患者的临床病理资料,探讨局部复发规律及其影响因素.结果:75例患者中,男性68例,女性7例；术前病变位于胸上段8例,胸中段53例,胸下段14例；术后病理分期:Tis期0例,T1期6例,T2期17例,T3期48例,T4期4例；N0期35例,N1期40例；临床分期:Ⅰ期5例,ⅡA期26例,ⅡB期7例,Ⅲ期35例,ⅣA期1例,ⅣB期1例；病理分型:鳞癌72例,腺癌2例,鳞癌小细胞癌混合型1例；食管癌根治术中行喉返神经旁淋巴结清扫14例,未行清扫61例；颈部淋巴结清扫9例,未行清扫66例.胸段食管癌根治术后局部复发时间为1～68个月,平均复发时间为13个月.局部复发部位包括双侧锁骨上区27例,上纵隔47例,中纵隔11例,下纵隔为0例,腹腔淋巴结转移4例,吻合口复发8例.结论:胸段食管癌根治术后局部复发位置主要是在双侧锁骨上区、中上纵隔和吻合口,且复发者主要为未行喉返神经淋巴结清扫和颈部淋巴结清扫的患者.建议应结合不同的手术方式及术后病理分期来决定是否应行术后放疗,放疗靶区则以双侧锁上区、中上纵隔和吻合口为主.

The value of clinicopathologic factors related to local recurrence in determining the clinical indications and target volume for postoperative radiotherapy in patients with thoracic esophageal cancer after curative esophagecotomy

Objective: To analyze the local recurrence pattern of thoracic esophageal cancer after curative resection, and to explore the clinical indication and target volume for postoperative radiotherapy in patients with thoracic esophageal cancer after curative resection. Methods: The clinicopathologic records from 75 patients suffering from local recurrence after radical esophagecotomy of thoracic esophageal cancer between Jan 2009 and Jun 2011 were retrospectively analyzed. The pattern and related factors for local recurrence were explored. Results: Of seventy-five patients who were proved having local recurrence, 68 patients were males and 7 patients were females. Before radical esophagecotomy, the primary cancers were located in upper-, middle-, and lower-thoracic esophagus in 8, 53 and 14 patients, respectively. The staging results after radical esophagecotomy showed that no patients had stage Tis, 6 patients had stage T1, 17 patients had stage T2, 48 patients had stage T3, and 4 patients had stage T4; 35 patients had stage N0, and 40 patients had stage Nl; 5 patients had stage Ⅰ, 26 patients had stage ⅡA, 7 patients had stage ⅡB, 35 patients had stage Ⅲ, 1 patient had stage ⅣA, and 1 patient had stage ⅣB. The pathologic results showed that 72 patients had squamous-cell cancer, 2 patients had adenocarcinoma, and 1 patient had mixed squamous-cell and small-cell cancer. During the process of radical esophagecotomy, 14 patients received the removal of lymph nodes along the recurrent laryngeal nerves, and 61 patients didn’t receive it; 9 patients received cervical lymphadenectomy, and 66 patients didn’t receive it. The local recurrence time was 1-68 months after radical esophagecotomy, and the average recurrence time was 13 months. The local recurrence positions included supraclavicular area in 27 patients, supraclavicular area in 47 patients, upper mediastinum in 11 patients, middle mediastinum in 11 patients, lower mediastinum in no patients, celiac lymph node metastasis in 4 patients, and anastomosis recurrence in 8 patients. Conclusion: The local recurrence after radical esophagecotomy for thoracic esophageal cancer mainly recurred in supraclavicular area, upper-middle mediastinum and anastomotic stoma. The patients suffering from local recurrence were mainly those who didn’t receive the removal of lymph nodes along the recurrent laryngeal nerves and the cervical lymphadenectomy. These results suggest that the postoperative prophylactic radiotherapy may be decided according to operative modes and TNM staging, and the target volume for postoperative radiation should include supraclavicular area, upper-middle mediastinum and anastomotic stoma.