Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지

Lymph Node Failure Pattern and Treatment Results of Esophageal Cancer Patients Treated with Definitive Radiotherapy

근치목적 방사선치료를 받은 식도암 환자의 림프절 재발양상과 치료성적

  • Lee, Sun-Young (Department of Radiation Oncology, Chonbuk National University Hospital) ;
  • Kwon, Hyoung-Cheol (Department of Radiation Oncology, Chonbuk National University Hospital) ;
  • Lee, Heui-Hwan (Department of Radiation Oncology, St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Jung-Soo (Department of Radiation Oncology, Chonbuk National University Hospital) ;
  • Kim, Soo-Geon (Department of Radiation Oncology, Jesushospital)
  • 이선영 (전북대학교병원 방사선종양학과) ;
  • 권형철 (전북대학교병원 방사선종양학과) ;
  • 이희관 (가톨릭대학교 의과대학 성모병원 방사선종양학교실) ;
  • 김정수 (전북대학교병원 방사선종양학과) ;
  • 김수곤 (예수병원 방사선종양학과)
  • Published : 2008.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. Materials and Methods: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women(mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion(17 patients), and mid portion(65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0(7 patients), T2N0-1M0(18 patients), T3N0-1M0(44 patients) and T4N0-1M0(13 patients). The mean follow up period was 15 months. Results: The various treatment outcomes included complete response(48 patients), partial response(31 patients) and no response(3 patients). The failure patterns of the lymph node were comprised of the regional lymph node(23 patients) and the distance lymph node which included celiac axis and gastric lymph node(13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the patients who appeared for regional and distant lymph node metastasis was 14.4 and 7.0 months, respectively. Conclusion: In locally advanced esophageal cancer patients, who were treated by definitive radiotherapy without celiac axis and gastric lymph node irradiation, the distant lymph node metastasis rate was high and the overall survival rate was lower compared to the regional lymph node metastasis. The incidence of regional and distant lymph node metastasis was high in patients who appeared beyond clinical stage T2 and received radiotherapy alone.

목적: 상부와 중앙 부위에서 발생한 식도암에서 복강 림프절 및 위 주변 림프절을 치료 범위에서 제외하고 근치목적의 방사선 치료를 시행한 경우 림프절 재발 양상과 치료성적에 대해 알아보고자 하였다. 대상 및 방법: 1986년 1월부터 2006년 12월까지 전북대학교병원에서 방사선 치료를 시행 받은 식도암 환자 중, T4N1M0이하 병기의 상부와 중앙부위에 생긴 식도암 환자를 대상으로 하였다. 대상 환자에서 복강 림프절 및 위 주변 림프절이 치료범위에 포함되지 않았으며, 방사선 단독 또는 항암화학요법과 병용으로 치료를 하였다. 방사선 치료는 6 MV와 10 MV 선형가속기(Siemens, 독일)를 이용하였으며, 외부방사선조사로 종양부위에 평균 60.5 Gy를 조사하였다. 항암화학치료는 5-Fluorouracil, Cisplatin, Docetaxel이 사용되었다. 108명 환자 중, 방사선 치료 범위에 위식도 접합부 및 복강 림프절과 위 주변 림프절이 치료 범위에 포함되지 않았고, 계획된 선량의 80% 이상이 조사되었으며, 조직학적 진단이 편평상피세포 암으로 확진된 82명을 분석하였으며, 방사선 치료 단독군은 51명, 항암화학 병용 군은 31명 이었다. 남녀 성비는 78명과 4명이었으며, 평균 연령은 63.2세이었다. 발생 부위는 상부와 중앙 부위가 각각 17명과 65명이었다. 병기별 환자는 T1N0-1M0 7명, T2N0-1M0 18명, T3N0-1M 44명 및 T4N0-1M0 13명 이었으며, 평균 추적 관찰 기간은 15개월 이었다. 결과: 방사선 치료 결과는 완전반응 48명, 부분반응 31명 및 무반응 3명이었다. 추적 검사 후 재발 양상은 인접 림프절 전이는 23명, 원발 림프절 전이는 13명, 인접 림프절 및 원발 부위 림프절 전이가 없는 경우는 10명, 추적 검사 중단이나 진단 거부로 인하여 평가가 이루어지지 않은 경우는 36명 이었다. 원발 림프절 전이가 확인 되었던 13명의 임상병기는 T1N0-1M0 3명, T2-4N0-1M0 10명으로 나타났으며, 원발 부위는 상부 1명, 중앙 부위가 12명이었고, 치료 방법은 방사선 치료 단독 9명, 항암화학 병용 4명 이었다. 그리고 치료성적은 완전반응 12명, 부분반응 1명으로 나타났다. 추적 검사 상 림프절 전이 확인 후 인접 림프절 전이 환자의 평균 생존 기간은 14.4개월이었으며, 원발 림프절 전이 환자의 평균 생존 기간은 7개월 이었다. 결론: T4N1 이하 병기의 상부와 중앙 부위에서 발생한 식도암에서 복강 림프절 및 위 주변 림프절을 치료범위에서 제외하고 근치목적의 방사선치료를 한 경우 동 부위에 전이 빈도가 높았고, 인접 림프절 전이와 비교하여 생존율이 감소하였다. 특히 임상 병기가 T2 이상 및 방사선치료 단독의 경우에서 복강 림프절 및 위 주변 림프절에 전이 빈도가 상대적으로 높았다.

Keywords

References

  1. Central Cancer Registry Center. Annual Report of the Central Cancer in Korea (2002.01-2002.12). 2003;11
  2. Pera M, Pera M. Recent changes in the epidemiology of esophageal cancer. Surg Oncol 2001;10:81-90 https://doi.org/10.1016/S0960-7404(01)00025-1
  3. Sons HU, Borchard F. Cancer of the distal esophagus and cardia. Ann Surg 1986;203:188-195 https://doi.org/10.1097/00000658-198602000-00013
  4. Koshy M, Esiashvilli N, Landry JC, Thomas CR Jr, Matthews RH. Multiple management modalities in esophageal cancer: combined modality management approach. Oncologist 2004;9:147-159 https://doi.org/10.1634/theoncologist.9-2-147
  5. Kok TC, Siersema PD. Neoadjuvant chemotherapy in operable esophageal squamous cell cancer: final report of a phase III multicenter randomized trial. Proc Am Clin Oncol 1997;16:277a
  6. Toita T, Ogawa K, Adachi G, et al. Concurrent chemoradiotherapy for squamous cell carcinoma of thoracic esophagus: fesibility and outcome of large regional field and high-dose external beam boost irradiation. Jpn J Clin Oncol 2001;31:375-381 https://doi.org/10.1093/jjco/hye084
  7. Chidel MA, Rice TW, Adelstein DJ, Kupelian PA, Suh JH, Becker M. Resectable esophageal carcinoma: local control with neoadjuvant chemotherapy and radiation therapy. Radiology 1999;213:67-72 https://doi.org/10.1148/radiology.213.1.r99oc1767
  8. Briboulet JF, Gignoux M, Triboulet JP, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the esophagus. N Engl J Med 1997;337:161-167 https://doi.org/10.1056/NEJM199707173370304
  9. Sharma A, Fidias P, Hayman A, Loomis SL, Taber KH, Aquino SL. Patterns of lymphadenopathy in thoracic malignancies. Radiographics 2004;24:419-434 https://doi.org/10.1148/rg.242035075
  10. Mandard AM, Chasle J, Marnary J, et al. Autopsy findings in 111 cases of esophageal cancer. Cancer 1981;48:329-335 https://doi.org/10.1002/1097-0142(19810715)48:2<329::AID-CNCR2820480219>3.0.CO;2-V
  11. Riquet M, Saab M, Le Pimpec Barthes F, Hidden G. Lymphatic drainage of the esophagus in the adult. Surg Radiol Anat 1993;15:209-211 https://doi.org/10.1007/BF01627708
  12. Denttis AS. Esophagus. In: Perez CA, Brady LW, eds. Principles and Practice of Radiation oncology. 4th ed. Philadelphia, PA: Lippincott Co. 2004;1282-1304
  13. Tai P, Van Dyk J, Yu E, Battista J, Stitt L, Coad L. Variability of target volume delineation in cervical esophageal cancer. Int J Radiat Oncol Biol Phys 1998;42:277-288
  14. Raman NV, Small W Jr. The role of radiation therapy in the management of esophageal cancer. Cancer Control 1999; 6:53-62
  15. Minsky BD. Cancer of the esophagus. In: Leibel SA, Phillips TL, eds. Textbook of Radiation Oncology. 2nd ed. Philadelphia, PA: Saunders Co. 2003;811-824
  16. Anderson LL, Lad TE. Autopsy findings in squamous cell carcinoma of the esophagus. Cancer 1982;50:1587-1590 https://doi.org/10.1002/1097-0142(19821015)50:8<1587::AID-CNCR2820500820>3.0.CO;2-S
  17. Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Principles of surgical treatment for carcinoma of the esophagus: analysis of lymph node involvement. Ann Surg 1981;194: 438-446 https://doi.org/10.1097/00000658-198110000-00007
  18. Heeren PA, Jager PL, Bongaerts F, van Dullemen H, Sluiter W, Plukker JT. Detection of distant metastases in esophageal cancer with 18F-FDG PET. J Nuc Med 2004; 45:980-987
  19. Aisner J, Forastiere A, Aroney R. Patterns of recurrence for cancer of the lung and esophagus. In: Wittes RE, ed. Cancer treatment symposia: proceedings of the workshop on patterns of failure after cancer treatment, vol 2. Washington DC, PA: Department of Health and Human Services. 1983:87
  20. Stein HJ, Feith M, Bruecher BL, Naehrig J, Sarbia M, Siewert JR. Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 2005;242:566-575
  21. Yim SB, Park JH, Baik HJ, et al. Long term results of surgical treatment for esophageal cancer. Korean Thorac Cardiovasc Surg 2001;34:148-155
  22. Kim YT, Sung SW, Kim JH. Long term survival after the resection of esophageal cancer. Korean Thorac Cardiovasc Surg 1999;32:653-659
  23. Kim HS, Yoo JW, Kim KM, et al. The recurrence and survival after complete resection of esophageal cancer. Korean Thorac Cardiovasc Surg 2003;36:411-417
  24. Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (RTOG 94-05) phase III trial of combined modality therapy for esophageal cancer: high dose (64.8 Gy) vs. standard dose (50.4 Gy) radiation therapy. J Clin Oncol 2002;20:1167-1174 https://doi.org/10.1200/JCO.20.5.1167
  25. Minsky BD. Carcinoma of the esophagus. Oncology 1999;13: 1225-1236
  26. Coia LR, Engstrom PF, Paul AR, Staffoard PM, Hanks GE. Long-term results of infusional 5-FU, mitomycin-C and radiation as primary management of esophageal carcinoma. Int J Radiat Oncol Biol Phys 1991;20:29-36 https://doi.org/10.1016/0360-3016(91)90134-P