104例胸段食管癌左胸路径术后局部复发规律及放疗靶区范围探讨

目的 探索胸段食管癌经左胸路径根治术后局部复发因素规律和影响因素,以及术后放疗靶区范围。方法 回顾分析本院2009—2012年经左胸路径根治术后胸段食管癌局部复发患者的临床资料,分析局部复发规律及影响因素,并依此确定术后放疗靶区范围。结果 共入组患者 104例,术前病变位于胸上段 14例、胸中段 68例、胸下段 22 例。术后病理分期为T_1b期 10例、T₂期 26例、T₃期 56例、T₄期 12例;N₀期 48例、N₁期 56例;Ⅰ期 6例、Ⅱ_a期 36例、Ⅱ_b期 21例、Ⅲ期 40例、Ⅳ_a期 1例。病理类型为鳞癌 101例、腺癌 2例、鳞癌小细胞癌混合型 1例。局部复发时间为 1~100个月(中位数12.8个月)。104例患者共发现局部复发部位136处。术后复发主要位于锁骨上、上中纵隔淋巴结(占83.8%),其中双侧锁骨上 35例、上纵隔 64例、中纵隔 15例、腹腔 9例、原瘤床 4例、吻合口 9例。放疗靶区应以双侧锁上区、中上纵隔及吻合口为主。结论 胸段食管癌左胸路径术后局部复发位置主要在双侧锁上区、中上纵隔及吻合口,因此放疗靶区应包括上述范围。

Pattern of relapse in left thoracotomy surgical treated patients with thoracic esophageal cancer and their value in target region delineation in postoperative radiotherapy

Objective To investigate the pattern of local recurrence in patients with thoracic esophageal cancer (EC) who have received radical surgery through a left thoracotomy, its influential factors, and the clinical target volume (CTV) for postoperative radiotherapy. Methods A retrospective analysis was performed on the clinical data of 104 patients with thoracic EC who experienced local recurrence after radical surgery through a left thoracotomy from January 2009 to June 2012. The pattern of local recurrence and its influential factors were analyzed, and the CTV for postoperative radiotherapy was determined accordingly. Results Of the 104 patients,14 had upper-thoracic EC, 68 had middle-thoracic EC, and 22 had lower-thoracic EC. According to UICC (2002) TNM classification, 10 of the patients had stage T_1b cancer, 26 had stage T₂ cancer, 56 had stage T₃ cancer, and 12 had stage T₄ cancer;48 had stage N₀ cancer, and 56 had stage N₁ cancer;6 had stage Ⅰ cancer, 36 had stage Ⅱ_a cancer, 21 had Ⅱ_b cancer, 40 had stage Ⅲ cancer, and 1 had stage Ⅳ_a cancer. In addition, 101 patients had squamous carcinoma, 2 had adenocarcinoma, and 1 had mixed squamous and small-cell carcinoma. The median time to local recurrence was 12.8 months (1—100 months). A total of 136 local recurrence sites were found in the 104 patients. Postoperative recurrence mainly occurred in the supraclavicular and upper/middle mediastinal lymph nodes (83.8%). Of the 136 local recurrence sites, 35 were in the bilateral supraclavicular areas, 64 in the upper mediastinum, 15 in the middle mediastinum, 9 in the abdominal cavity, 4 in the original tumor bed, and 9 at the anastomosis. The CTV for postoperative radiotherapy should mainly include bilateral supraclavicular areas, upper/middle mediastinum, and anastomosis. Conclusions Local recurrence mainly occurred in thebilateral supraclavicular areas, upper/middle mediastinum, and anastomosis in patients with thoracic EC who have received radical surgery through a left thoracotomy. Therefore, the CTV for postoperative radiotherapy should include the above areas.