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Japanese Journal of Clinical Oncology Advance Access originally published online on November 28, 2008
Japanese Journal of Clinical Oncology 2009 39(2):86-91; doi:10.1093/jjco/hyn131
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© The Author (2008). Published by Oxford University Press. All rights reserved

Determination of the Irradiation Field for Clinical T1-T3N0M0 Thoracic/Abdominal Esophageal Cancer Based on the Postoperative Pathological Results

Tatsuya Nakamura, Syunzo Hatooka, Takeshi Kodaira, Hiroyuki Tachibana, Natsuo Tomita, Rie Nakahara, Haruo Inokuchi, Nobutaka Mizoguchi, Akinori Takada, Masayuki Shinoda and Nobukazu Fuwa

Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan

For reprints and all correspondence: Tatsuya Nakamura, Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama City, Fukushima 963-8052, Japan. E-mail: tatsuya.nakamura{at}nifty.com

Received September 9, 2008; accepted October 22, 2008

Objective: In patients with thoracic/abdominal esophageal cancer with no clinical evidence of lymph node metastasis, there is no consensus about whether the irradiation field should include regional lymph nodes. In this study, the extent of the irradiation field for clinical stage T1-3N0M0 esophageal cancer was determined based on the postoperative pathological results.

Methods: From July 1989 to June 2008, 103 patients diagnosed with clinical stage T1-3N0M0 thoracic/abdominal esophageal cancer underwent standard esophagectomy and regional lymph node dissection at the Aichi Cancer Center Hospital. Of these 103 patients, the pathological results of the resected specimens could be confirmed in 95 (92%) patients. The pathological lymphatic spread was reviewed retrospectively, and the extent of the irradiation field was determined based on the postoperative pathological results.

Results: Of 95 patients with clinical stage T1-3N0M0 esophageal cancer, 40 (42.1%) had pathological lymph node metastases, and the frequency of nodal metastases was studied by tumor location. The rates of lymph node metastases for the upper, middle, lower and abdominal esophagus were 37.5%, 32.5%, 46% and 70%, respectively.

Conclusions: Pathological lymph nodes metastases are often seen after operation in clinical stage T1-3N0M0 esophageal cancer. In the present study, the optimal lymph nodes to be included in the irradiation field were determined according to the primary site in the esophagus.

Key Words: radiation therapy • surgery • pathology


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