The Value Of Radiotherapy For Thoracic Esophageal Squamous Cell Carcinoma With Supraclavicular Lymph Node Metastasis

Objective: To retrospectively analyze the value and prognosis of radiotherapy for thoracic esophageal squamous cell carcinoma with supraclavicular lymph node metastasis(SCLN).Methods: 189 patients with thoracic esophageal squamous cell carcinoma with SCLN metastasis were selected retrospectively,including 137 males and 52 females.According to diagnosis time,86 patients were divided into two groups: the group of 86 patients with SCLN metastasis at the first diagnosis,the group of 103 patients with SCLN metastasis after treatment,including 74 patients with SCLN metastasis after operation and 29 patients with SCLN after radiotherapy and chemotherapy.According to whether there were mediastinal and visceral metastases in patients with SCLN metastasis,the patients divided into SCLN metastasis group alone(n=53),combined with mediastinal lymph node metastasis group(n=83),combined with visceral metastasis group(n=53).Based on the treatment methods after lymph node metastasis,the patients were divided into chemoradiotherapy group(n=87),radiotherapy group(n=49),chemotherapy group(n=33)and lymphadenectomy group(n=20).The patients in chemoradiotherapy group or radiotherapy group were treated with 6MV X-ray,three-dimensional conformal radiotherapy combined with local electron beam irradiation or intensity-modulated radiotherapy.The target area of radiotherapy was involved field irradiation,the chemotherapy regimens were platinum-based chemotherapy or single chemotherapy drug.The surgical methods were lymph node dissection with or without radical resection of esophageal cancer.Results: The median survival time was 12.7 months(2～137 months)in the whole group,12.2 months(2～88 months)for esophageal cancer patients with SCLN metastasis at the first diagnosis,13.2 months(2～137 months)in the post-treatment group,among which 15 months(2～137 months)in the postoperative group and 8.3 months(2 ～ 88months)in the post chemoradiotherapy group.In the whole group and the first diagnosis group,the long～term survival rate of the simple SCLN metastasis group was higher than that of SCLN metastasis combined with visceral metastasis group,but there was no significant difference in the survival rate of the SCLN metastasis combined with visceral metastasis group after treatment(P=0.504).In different rescue treatment groups,the survival time of the whole group of patients with SCLN metastasis in the chemoradiotherapy group and lymph node dissection group were both higher than that in the chemotherapy group(P<0.05),and there was no significant difference between the chemoradiotherapy group and lymph node dissection group(P=0.362).The survival rate of the chemoradiotherapy group in the first diagnosis group was higher than that of the radiotherapy group and chemotherapy group(P<0.05),and among them there was no significant difference(P=0.726).Among the 26 patients with simple SCLN metastasis in the first diagnosis group,the survival rate in the chemoradiotherapy group was higher than that in the chemoradiotherapy group and the chemoradiotherapy group(P<0.05),and there was no significant difference between the chemoradiotherapy group and the lymph node dissection group(P=0.726).In the post-treatment group,the survival rate of the chemoradiotherapy group was significantly higher than that of the chemotherapy alone group(P=0.059),and the survival rate of the lymph node dissection group was significantly higher than that of the chemotherapy alone group(P<0.05),but there was no significant difference between the chemoradiotherapy group and the lymph node dissection group(P=0.233).In the whole group,the survival rate after SCLN metastasis in the≥ 60 Gy group was higher than that in the < 60 Gy group,and the difference was close to statistical significance(P=0.066).Although no statistical difference was found in the survival rate after SCLN metastasis between the≥ 60 Gy group and the < 60 Gy group in the first diagnosis group and the post-treatment group,the survival rate of the ≥ 60 Gy group was better than the < 60 Gy group according to the survival curve.Cox multivariate survival analysis showed that treatment was an independent prognostic factor affecting the survival time of patients with SCLN metastasis at the first diagnosis;Lesion length of esophageal carcinoma and radiotherapy dose of SCLN metastasis lymph nodes were the independent prognostic factors affecting the survival time of patients with SCLN metastasis after treatment.Conclusions:1.The survival rate of patients with SCLN metastasis after operation was higher than that of patients with first diagnosis of SCLN metastasis and patients with SCLN metastasis after chemoradiotherapy.2.The survival rate after SCLN metastasis of patients with SCLN metastasis after chemoradiotherapy and surgery was better than that of patients treatment with chemotherapy alone.3.The survival rate after SCLN metastasis of patients with SCLN metastasis alone was better than that of patients with mediastinal or visceral metastasis.4.The survival after SCLN metastasis of esophageal cancer patients with SCLN metastasis can be improved by≥60Gy Radiotherapy dose.