Efficacy of adjuvant radiotherapy for lower thoracic esophageal squamous cell carcinoma patients after radical operation with anastomosis above aortic arch_West China Medical Journal

Authors：

MENG Mi ^1,2 , LIU Jia ³ , LAI Jialu ⁴ , ZHANG Yingjie ⁴ , DENG Zhonghua ⁴ , LI An ⁴ , GONG Youling ¹ , XUE Jianxin ¹ ,  ZHOU Lin ¹

1. Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Thoracic Oncology, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P. R. China;
3. Department of Oncology, Chengdu First People’s Hospital, Chengdu, Sichuan 610016, P. R. China;
4. Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHOU Lin, Email: drzhoulin@163.com

Keywords：

Esophageal squamous cell carcinoma; lower thoracic; anastomosis above aortic arch; adjuvant radiotherapy

DOI：

10.7507/1002-0179.202104225

Video：

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Objective To analyze the efficacy of and recurrence mode after adjuvant radiotherapy for lower thoracic esophageal squamous cell carcinoma (TESCC) patients after radical operation with anastomosis above aortic arch. Methods Sixty-three patients with lower TESCC who received adjuvant radiotherapy after R0 radical operation with anastomosis above aortic arch between February 2011 and February 2019 were retrospectively enrolled. The clinical tumor volume (CTV) included anastomotic stoma, and lymph node drainage area in mediastinum and upper abdomen. The survival status, recurrence and metastasis of tumors, and the influencing factors were analyzed. Results The 1-, 2-, and 3-year overall survival rates were 98.3%, 83.3%, and 63.7%, respectively. The median disease-free survival (DFS) was 33 months [95% confidence interval (23.2, 42.8) months], and the 1-, 2-, and 3-year DFS rates were 76.3%, 58.5%, and 41.7%, respectively. Patients with N0-1 had longer DFS than those with N2-3 (median: not reached vs. 15 months, P=0.045). The recurrence rate of anastomotic site was 7.9%. The recurrence rates of lymph nodes in supraclavicular region, upper middle mediastinum, and upper abdomen were 4.8%, 15.9%, and 1.6%, respectively. The distant metastasis rate was 17.5%. The incidence of grade 2-3 radiation pneumonitis, grade 3 anastomotic stenosis, and grade 3 tracheal fistula were 4.8%, 3.2%, and 1.6%, respectively. Conclusions N2-3 is a poor prognostic factor for such patients. Regional lymph node recurrence is mainly revealed in the middle and upper mediastinum. Whether the CTV should include anastomotic stoma and lymph node drainage area in lower mediastinum and upper abdomen is questionable.

Citation： MENG Mi, LIU Jia, LAI Jialu, ZHANG Yingjie, DENG Zhonghua, LI An, GONG Youling, XUE Jianxin, ZHOU Lin. Efficacy of adjuvant radiotherapy for lower thoracic esophageal squamous cell carcinoma patients after radical operation with anastomosis above aortic arch. West China Medical Journal, 2023, 38(2): 246-251. doi: 10.7507/1002-0179.202104225 Copy

1.	Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
2.	Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl), 2022, 135(5): 584-590.
3.	Biere SS, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg, 2011, 28(1): 29-35.
4.	Schreiber D, Rineer J, Vongtama D, et al. Impact of postoperative radiation after esophagectomy for esophageal cancer. J Thorac Oncol, 2010, 5(2): 244-250.
5.	Yang J, Zhang W, Xiao Z, et al. The impact of postoperative conformal radiotherapy after radical surgery on survival and recurrence in pathologic T3N0M0 esophageal carcinoma: a propensity score-matched analysis. J Thorac Oncol, 2017, 12(7): 1143-1151.
6.	Chen SB, Weng HR, Wang G, et al. The impact of adjuvant radiotherapy on radically resected T3 esophageal squamous cell carcinoma. J Cancer Res Clin Oncol, 2016, 142(1): 277-286.
7.	Zhang Z, Xu L, Di X, et al. A retrospective study of postoperative radiotherapy for locally advanced esophageal squamous cell carcinoma. Ann Palliat Med, 2019, 8(5): 708-716.
8.	Zhang Y, Zhang Y, Peng L, et al. Research progress on the predicting factors and coping strategies for postoperative recurrence of esophageal cancer. Cells, 2022, 12(1): 114.
9.	Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
10.	Ajani JA, D’Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
11.	Xiao ZF, Yang ZY, Liang J, et al. Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg, 2003, 75(2): 331-336.
12.	Chang X, Chen J, Xiao Z, et al. Recurrence risk stratification based on a competing-risks nomogram to identify patients with esophageal cancer who may benefit from postoperative radiotherapy. Ther Adv Med Oncol, 2021, 13: 17588359211061948.
13.	周鑫鹏, 梅新宇. N1 期胸段食管鳞状细胞癌淋巴结转移规律及预后分析. 中国胸心血管外科临床杂志, 2022, 29(12): 1587-1593.
14.	肖泽芬, 周宗玫, 吕纪马, 等. 胸段食管癌淋巴结转移规律与术后放疗范围的探讨. 中华放射肿瘤学杂志, 2008, 17(6): 427-431.
15.	陈跃军, 邹求益, 朱广, 等. 胸段食管癌淋巴结转移特点的临床研究. 中华胃肠外科杂志, 2013, 16(9): 835-837.
16.	Huang W, Li B, Gong H, et al. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: a report of 1077 cases. Radiother Oncol, 2010, 95(2): 229-233.
17.	Ding X, Zhang J, Li B, et al. A meta-analysis of lymph node metastasis rate for patients with thoracic oesophageal cancer and its implication in delineation of clinical target volume for radiation therapy. Br J Radiol, 2012, 85(1019): e1110-1119.
18.	刘晓, 章文成, 于舒飞, 等. T2-3N0M0 期食管癌 R0 术后失败模式分析—术后放疗潜在价值与意义. 中华放射肿瘤学杂志, 2015, 24(1): 19-24.
19.	宋振焱, 焦言, 李洪升, 等. 食管鳞癌根治术后失败模式分析. 中华肿瘤防治杂志, 2018, 25(2): 126-130.
20.	沈文斌, 高红梅, 祝淑钗, 等. pT3N0M0 期胸段食管鳞癌患者术后失败原因分析及其术后放疗思考. 中华放射肿瘤学杂志, 2017, 26(4): 394-399.
21.	沈文斌, 高红梅, 祝淑钗, 等. T1-4N0-1M0 期胸段食管鳞癌根治性切除术后失败模式对术后辅助治疗的意义. 中华放射医学与防护杂志, 2018, 38(4): 265-272.
22.	李春阳, 余静, 沈九零, 等. 胸段食管鳞癌术后复发模式及淋巴结复发规律. 中华放射肿瘤学杂志, 2019, 28(9): 673-676.
23.	Li CL, Zhang FL, Wang YD, et al. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer. Oncol Lett, 2013, 5(1): 355-359.

1. Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
2. Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl), 2022, 135(5): 584-590.
3. Biere SS, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg, 2011, 28(1): 29-35.
4. Schreiber D, Rineer J, Vongtama D, et al. Impact of postoperative radiation after esophagectomy for esophageal cancer. J Thorac Oncol, 2010, 5(2): 244-250.
5. Yang J, Zhang W, Xiao Z, et al. The impact of postoperative conformal radiotherapy after radical surgery on survival and recurrence in pathologic T3N0M0 esophageal carcinoma: a propensity score-matched analysis. J Thorac Oncol, 2017, 12(7): 1143-1151.
6. Chen SB, Weng HR, Wang G, et al. The impact of adjuvant radiotherapy on radically resected T3 esophageal squamous cell carcinoma. J Cancer Res Clin Oncol, 2016, 142(1): 277-286.
7. Zhang Z, Xu L, Di X, et al. A retrospective study of postoperative radiotherapy for locally advanced esophageal squamous cell carcinoma. Ann Palliat Med, 2019, 8(5): 708-716.
8. Zhang Y, Zhang Y, Peng L, et al. Research progress on the predicting factors and coping strategies for postoperative recurrence of esophageal cancer. Cells, 2022, 12(1): 114.
9. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
10. Ajani JA, D’Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
11. Xiao ZF, Yang ZY, Liang J, et al. Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg, 2003, 75(2): 331-336.
12. Chang X, Chen J, Xiao Z, et al. Recurrence risk stratification based on a competing-risks nomogram to identify patients with esophageal cancer who may benefit from postoperative radiotherapy. Ther Adv Med Oncol, 2021, 13: 17588359211061948.
13. 周鑫鹏, 梅新宇. N1 期胸段食管鳞状细胞癌淋巴结转移规律及预后分析. 中国胸心血管外科临床杂志, 2022, 29(12): 1587-1593.
14. 肖泽芬, 周宗玫, 吕纪马, 等. 胸段食管癌淋巴结转移规律与术后放疗范围的探讨. 中华放射肿瘤学杂志, 2008, 17(6): 427-431.
15. 陈跃军, 邹求益, 朱广, 等. 胸段食管癌淋巴结转移特点的临床研究. 中华胃肠外科杂志, 2013, 16(9): 835-837.
16. Huang W, Li B, Gong H, et al. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: a report of 1077 cases. Radiother Oncol, 2010, 95(2): 229-233.
17. Ding X, Zhang J, Li B, et al. A meta-analysis of lymph node metastasis rate for patients with thoracic oesophageal cancer and its implication in delineation of clinical target volume for radiation therapy. Br J Radiol, 2012, 85(1019): e1110-1119.
18. 刘晓, 章文成, 于舒飞, 等. T2-3N0M0 期食管癌 R0 术后失败模式分析—术后放疗潜在价值与意义. 中华放射肿瘤学杂志, 2015, 24(1): 19-24.
19. 宋振焱, 焦言, 李洪升, 等. 食管鳞癌根治术后失败模式分析. 中华肿瘤防治杂志, 2018, 25(2): 126-130.
20. 沈文斌, 高红梅, 祝淑钗, 等. pT3N0M0 期胸段食管鳞癌患者术后失败原因分析及其术后放疗思考. 中华放射肿瘤学杂志, 2017, 26(4): 394-399.
21. 沈文斌, 高红梅, 祝淑钗, 等. T1-4N0-1M0 期胸段食管鳞癌根治性切除术后失败模式对术后辅助治疗的意义. 中华放射医学与防护杂志, 2018, 38(4): 265-272.
22. 李春阳, 余静, 沈九零, 等. 胸段食管鳞癌术后复发模式及淋巴结复发规律. 中华放射肿瘤学杂志, 2019, 28(9): 673-676.
23. Li CL, Zhang FL, Wang YD, et al. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer. Oncol Lett, 2013, 5(1): 355-359.

West China Medical Journal

Efficacy of adjuvant radiotherapy for lower thoracic esophageal squamous cell carcinoma patients after radical operation with anastomosis above aortic arch

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