Initial experience of individualized chemoradiotherapy for superficial esophageal cancers based on the sentinel lymph node concept

Takuji Kaburagi, Hiroya Takeuchi, Hirofumi Fujii, Yoshiro Saikawa, Koji Murakami, Junichi Fukada, Naoyuki Shigematsu, Soji Ozawa, Nobutoshi Ando, Yuukou Kitagawa

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Esophageal squamous cell carcinomas (ESCCs) invading the muscularis mucosae (T1a-MM) cause subclinical node metastasis in approximately 10 % of cases. When chemoradiotherapy (CRT) is administered to T1a-MM or deeper ESCC, prophylactic irradiation of areas with a risk of subclinical nodal metastasis may improve disease control. We had an opportunity for clinical observation of the status of lymph nodes in the patients whose hot spots in lymphoscintigraphy before CRT had been included within the irradiation field. Methods: We retrospectively investigated patients selected using following criteria: (1) cT1a-MM and cT1b without previous treatments, or pT1a-MM and pT1b cancers proved by previous endoscopic resections; (2) patients with neither clinical nodal nor distant metastasis; (3) patients whose hot spots detected by lymphoscintigraphy had been included within the irradiation fields. Lymphoscintigraphy had been examined with endoscopic injection of a radioisotope around the primary lesion before CRT. Results: Sixteen patients met the inclusion criteria. Of these patients [T1a-MM (4 cases), T1b-SM1 (2 cases), and T1b-SM2 (10 cases)], there were 9 definitive CRTs and 7 adjuvant CRTs after endoscopic resections. The median dose of irradiation was 60 Gy to the primary tumors and 46 Gy to the hot spots. All patients with definitive CRT achieved complete remission. At the median follow-up of 76.6 months, there was no lymph node recurrence. Conclusions: Prophylactic irradiation of the hot spots in lymphoscintigraphy may be effective. This result warrants further evaluation concerning the validity of irradiation field settings based on lymphoscintigraphic findings in patients with superficial ESCCs.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalEsophagus
Volume9
Issue number3
DOIs
Publication statusPublished - 2012 Sep

Fingerprint

Chemoradiotherapy
Esophageal Neoplasms
Lymphoscintigraphy
Neoplasm Metastasis
Lymph Nodes
Sentinel Lymph Node
Radioisotopes
Neoplasms
Mucous Membrane
Observation
Recurrence
Injections
Esophageal Squamous Cell Carcinoma

Keywords

  • Chemoradiotherapy
  • Esophageal cancer
  • Lymphoscintigraphy
  • Radiotherapy
  • Sentinel lymph node

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Initial experience of individualized chemoradiotherapy for superficial esophageal cancers based on the sentinel lymph node concept. / Kaburagi, Takuji; Takeuchi, Hiroya; Fujii, Hirofumi; Saikawa, Yoshiro; Murakami, Koji; Fukada, Junichi; Shigematsu, Naoyuki; Ozawa, Soji; Ando, Nobutoshi; Kitagawa, Yuukou.

In: Esophagus, Vol. 9, No. 3, 09.2012, p. 147-152.

Research output: Contribution to journalArticle

Kaburagi, Takuji ; Takeuchi, Hiroya ; Fujii, Hirofumi ; Saikawa, Yoshiro ; Murakami, Koji ; Fukada, Junichi ; Shigematsu, Naoyuki ; Ozawa, Soji ; Ando, Nobutoshi ; Kitagawa, Yuukou. / Initial experience of individualized chemoradiotherapy for superficial esophageal cancers based on the sentinel lymph node concept. In: Esophagus. 2012 ; Vol. 9, No. 3. pp. 147-152.
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T1 - Initial experience of individualized chemoradiotherapy for superficial esophageal cancers based on the sentinel lymph node concept

AU - Kaburagi, Takuji

AU - Takeuchi, Hiroya

AU - Fujii, Hirofumi

AU - Saikawa, Yoshiro

AU - Murakami, Koji

AU - Fukada, Junichi

AU - Shigematsu, Naoyuki

AU - Ozawa, Soji

AU - Ando, Nobutoshi

AU - Kitagawa, Yuukou

PY - 2012/9

Y1 - 2012/9

N2 - Background: Esophageal squamous cell carcinomas (ESCCs) invading the muscularis mucosae (T1a-MM) cause subclinical node metastasis in approximately 10 % of cases. When chemoradiotherapy (CRT) is administered to T1a-MM or deeper ESCC, prophylactic irradiation of areas with a risk of subclinical nodal metastasis may improve disease control. We had an opportunity for clinical observation of the status of lymph nodes in the patients whose hot spots in lymphoscintigraphy before CRT had been included within the irradiation field. Methods: We retrospectively investigated patients selected using following criteria: (1) cT1a-MM and cT1b without previous treatments, or pT1a-MM and pT1b cancers proved by previous endoscopic resections; (2) patients with neither clinical nodal nor distant metastasis; (3) patients whose hot spots detected by lymphoscintigraphy had been included within the irradiation fields. Lymphoscintigraphy had been examined with endoscopic injection of a radioisotope around the primary lesion before CRT. Results: Sixteen patients met the inclusion criteria. Of these patients [T1a-MM (4 cases), T1b-SM1 (2 cases), and T1b-SM2 (10 cases)], there were 9 definitive CRTs and 7 adjuvant CRTs after endoscopic resections. The median dose of irradiation was 60 Gy to the primary tumors and 46 Gy to the hot spots. All patients with definitive CRT achieved complete remission. At the median follow-up of 76.6 months, there was no lymph node recurrence. Conclusions: Prophylactic irradiation of the hot spots in lymphoscintigraphy may be effective. This result warrants further evaluation concerning the validity of irradiation field settings based on lymphoscintigraphic findings in patients with superficial ESCCs.

AB - Background: Esophageal squamous cell carcinomas (ESCCs) invading the muscularis mucosae (T1a-MM) cause subclinical node metastasis in approximately 10 % of cases. When chemoradiotherapy (CRT) is administered to T1a-MM or deeper ESCC, prophylactic irradiation of areas with a risk of subclinical nodal metastasis may improve disease control. We had an opportunity for clinical observation of the status of lymph nodes in the patients whose hot spots in lymphoscintigraphy before CRT had been included within the irradiation field. Methods: We retrospectively investigated patients selected using following criteria: (1) cT1a-MM and cT1b without previous treatments, or pT1a-MM and pT1b cancers proved by previous endoscopic resections; (2) patients with neither clinical nodal nor distant metastasis; (3) patients whose hot spots detected by lymphoscintigraphy had been included within the irradiation fields. Lymphoscintigraphy had been examined with endoscopic injection of a radioisotope around the primary lesion before CRT. Results: Sixteen patients met the inclusion criteria. Of these patients [T1a-MM (4 cases), T1b-SM1 (2 cases), and T1b-SM2 (10 cases)], there were 9 definitive CRTs and 7 adjuvant CRTs after endoscopic resections. The median dose of irradiation was 60 Gy to the primary tumors and 46 Gy to the hot spots. All patients with definitive CRT achieved complete remission. At the median follow-up of 76.6 months, there was no lymph node recurrence. Conclusions: Prophylactic irradiation of the hot spots in lymphoscintigraphy may be effective. This result warrants further evaluation concerning the validity of irradiation field settings based on lymphoscintigraphic findings in patients with superficial ESCCs.

KW - Chemoradiotherapy

KW - Esophageal cancer

KW - Lymphoscintigraphy

KW - Radiotherapy

KW - Sentinel lymph node

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