胸段食管鳞癌术后复发模式及术后放疗靶区的研究北大核心

目的:研究胸段食管鳞癌术后复发模式,为术后放疗靶区勾画提供参考。方法:回顾分析我院2012年7月至2017年5月收治术后复发的81例胸段食管鳞癌患者的临床资料,参照AJCC第八版食管癌分期,将第1-8M站定义为上中纵隔淋巴结区,8Lo、9、15站定义为下纵隔淋巴结区,16-20站定义为上腹部淋巴结区。标记患者的复发部位,并分析局部复发、区域复发和远处转移的模式。结果:中位复发时间为12个月(2~103个月)。6例(7.4%)患者发生单纯局部复发,64例(79.0%)患者发生区域复发,11例(13.6%)患者发生远处转移。区域淋巴结复发中最高危的复发区域为上中纵隔淋巴引流区,此区域包含了82.8%的复发淋巴结,其次为上腹部淋巴结引流区(13.6%)。11例患者发生上腹部淋巴结复发,其中10(90.9%)例为胸下段,7例(63.6%)患者术后分期≥Ⅲ_(b)期。结论:胸段食管鳞癌术后复发模式以区域淋巴结复发为主,上中纵隔淋巴引流区为最高危复发区域,术后放疗靶区应重点包含。对于术后分期较晚的胸下段食管鳞癌,上腹部淋巴结引流区可能需要涵盖在放疗靶区内。吻合口、瘤床和下纵隔复发风险低,可不必常规涵盖在放疗靶区内。

Study on recurrent patterns after radical surgery for thoracic esophageal squamous cell carcinoma and postoperative radiotherapy target volume

Objective:To investigate the patterns of treatment failure after radical surgery for thoracic esophageal squamous cell carcinoma(TESCC),proposing a definition of clinical target volume(CTV)for postoperative radiotherapy(PORT).Methods:Clinical data of 81 TESCC patients who recurred after a radical esophagectomy in the our hospital from July 2012 to May 2017 were retrospectively analyzed.Regional lymph node stations 1 to 8M were defined as the upper-middle mediastinum region(UMMR),stations 8Lo,9 and 15 were defined as the inferior mediastinum region(IMR),and stations 16 to 20 were defined as the upper abdominal lymph node region(UAR),according to the AJCC 8th edition-defined classification of esophageal carcinoma.The patterns of first discovered failure were assessed,including local recurrence(including anastomoses and tumor bed),regional recurrence and distal areas.Results:The median time to progression was 12 months(range from 2 to 103 months).Among all 81 patients,6(7.4%)patients experienced local recurrence alone,64 patients(79.0%)experienced regional recurrence,and 11 patients(13.6%)presented with distant metastasis.The highest risk region of lymph node recurrence was the UMMR,which contained 82.8% of the recurrent lymph nodes,after that,followed by the UAR(13.6%).With regard to 11 cases of UAR,10(90.9%)were lower TESCC,and 7(63.6%)were graded as ≥ pathological stage Ⅲb.Conclusion:The main pattern of treatment failure after radical surgery for TESCC was regional recurrence.The highest risk region of lymph node recurrence is UMMR,which should be conventionally covered in the target volume in PORT.The UAR should be considered as an elective target volume for lower TESCC at pathological stage Ⅲb and higher,nevertheless the anastomoses,tumor bed and the IMR might not necessarily be included in the PORT volume for thoracic ESCC,due to the low recurrence rate.