| Objective To analyze intrathoracic or extrathoracic recurrence patterns after surgical resection of thoracic esophageal squamous cell carcinoma (TESCC), and its help for further modify and improvement the target of postoperative radiation therapy.Methods One hundred and ninety-five patients who had undergone resection of TESCC at the Cancer Hospital&Institute Chinese Academy of Medical Sciences from April1999to July2007. Sites of failure on different primary location of esophageal cancer were documented.Results Patients with upper or middle thoracic esophageal cancer had high proporation of intrathoracic recurrence. Patients with lower thoracic esophageal cancer had more intrathoracic reccurence and abdominal lymph node metastatic recurrence. Pathological lymph node status has nothing to do with intrathoracic recurrence, supraclavicular lymph nodes (SLNs) or distant metastasis(χ2=1.584,0.055,0.036, P=0.134,0.467,0.489), whereas the chance of abdominal lymph node metastases in N positive patients was significantly higher than that in NO patients (28.7%:10.6%, χ2=9.941, P=0.001), and so did in middle thoracic esophageal cancer (20.0%:5.6%,χ2=5.671, P=0.015); Anastomotic recurrence rate of proximal resection margin no more than3cm was significantly higher compared to those more than3cm(25%vs.11.3%, χ2=5.650, P=0.019).Conclusions Mediastinum is the most common recurrence site. According to recurrence site, the following radiation targets recommended:when the tumor was located at the upper or in the middle thoracic esophagus with negative N status, the mediastinum, the tumor bed and the supraclavicular region should be included as postoperative RT target; when the tumor was located at the middle thoracic esophagus with positive N or located at the lower thoracic esophagus, the abdominal lymph node should be added. If the proximal resection margin was no more than3cm, the anastomoticstoma should be preceded. Objective To analyzed retrospectively the clinical therapeutic effect and toxicities ofintensity-modulated radiotherapy (IMRT) for resected stage II/III thoracic esophagealsquamous cell carcinoma (TESCC).Methods A total of237patients with resected TESCC underwent IMRT at the CancerHospital (Institute), Chinese Academy of Medical Sciences between2004.1to2009.6enrolled. Postoperative radiotherapy applied via IMRT with a median total dose of60Gy.The Kaplain-Meier method was used to calculate the survival rates, and the log-rank testwas used for univariate analysis. The Cox proportional model was used for multivariateanalysis.Results The follow-up rate was99.6%.210and86patients were followed to at3and5years, respectively. The1-,3-and5-year overall survival (OS) rates for all the patientswere89.5%.56.2%and44.4%,respectively. For the stage IIa, IIb,and III stage2patients, the5-year OS rates were63.2%,42.7%and38.4%,respectively9.039,P=0.011). Univariate analysis showed that the significant prognostic factors includeUICC2002stage, lymphatic metastasis, the number of metastatic lymph nodes, thedegree of metastatic lymph nodes, the degree of differentiation, and vascular tumorthrombus (2x=9.039,8.530,11.265,6.307,5.533,8.523,尸=0.011,0.003,0.010,0.012,0.019,0.004). Multivariate analysis revealed that the degree of differentiation,lymphatic metastasis and vascular tumor thrombus were independent prognosticfactors(x2=4.270,4.982,7.597,P=0.039,0.026,0.006). Treatment failure occurredin60patients because of systemic metastases,16patients developing cervical lymphnode recurrence,16patients undergoing abdominal lymph node metastases, and29patients with intrathoracic recurrence. Four patients had grade2or worse latetreatment-related anastomotic stenosis, and7patients died rfom late treatment-relatedgastrointestinal bleeding.Conclusions Postoperative prophylactic IMRT of TESCC can provide a favorablelocal control rate and acceptable toxicity. Postoperative radiotherapy should be includedinto the standard treatment of Stage III TESCC or TESCC with lymph node metastasis. Objective To retrospectively analyze the effectiveness of postoperative intensity-modulated radiotherapy (IMRT) for resected stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma (TESCC), and evaluate the outcome of postoperative IMRT.Methods From January2004to June2009,1209patients with TESCC underwent radical resection with or without postoperative IMRT were eligible for analysis at the Cancer Hospital (Institute), Chinese Academy of Medical Sciences. Patients were grouped to surgery only (n=972) and surgery plus postoperative IMRT (n=237). Postoperative radiotherapy applied via IMRT with a median total dose of60Gy. The Kaplain-Meier method was used to calculate the survival rates, and the log-rank test was used for univariate analysis.Results The follow-up rate was94.3%.1122and595patients were followed to at3and5years respectively. The1-,3-and5-year overall survival (OS) rates for all the patients were84.6%,55.8%and47.2%, respectively. For the stage Ⅱa,Ⅱb, and Ⅲ patients, the5-year OS rates were59.0%,47.4%and30.8%respectively(χ2=98.630, P=0.000). The5-year OS rates of patients who were lymph node negative and positive were58.8%and34.1%(χ2=80.975, P=0.000), respectively. The overall5-year OS rate was47.8%for the S group and44.4%(χ2=0.005, P=0.944) for the S plus IMRT group. Postoperative prophylactic IMRT improved the5-year survival rate in TESCC patients with positive lymph node metastases (38.9%vs31.7%, χ2=8.497, P=0.004) and in patients with stage Ⅲ disease (38.3%vs27.4%, χ2=8.844, P=0.00) compared with similar patients who did not receive radiation therapy. The3-year and5-year OS rates of patients who were lymph node negative were66.2%and58.3%for the S group and73.9%and64.3%for the S plus IMRT group respectively (χ2=0.709, P=0.400). The unspecified death of119patients left1090patients for a study of site and cause of failure. Treatment failure occurred in537patients with the total recurrence rate49.3%, and postoperative radiotherapy reduced the incidence of intrathoracic recurrence (12.8%vs27.8%, χ2=21.528, P=0.000). It is also apparent that postoperative IMRT reduced the incidence of intrathoracic recurrence who were lymph node negative (10.2%vs22.6%, χ2=4.067, P=0.043). Postoperative IMRT reduced the incidence of intrathoracic and supraclavicular recurrence with regard to the lymph node positive patients (13.6%vs 36.0%,χ2=28.814, P=0.000;6.2%vs13.2%, χ2=5.883, P=0.015), but no reduction found in the abdomen.Conclusions Postoperative prophylactic IMRT improved the5-year survival rate in TESCC patients with in patients with stage Ⅲ disease and positive lymph node metastases compared with similar patients who did not receive radiation therapy. Whether this survival benefit can apply to lymph node negative patients needs further elucidation.
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