title: Nodal metastasis from locally advanced esophageal cancer: how neoadjuvant therapy modifies their frequency and distribution.
abstract: BACKGROUND
  Neoadjuvant chemoradiotherapy (CT-RT) before esophagectomy seems to affect the number of nodal metastasis and to alter the distribution of those that remain. The aim of this study was to define how neoadjuvant chemoradiotherapy changes nodal metastasis patterns in locally advanced esophageal cancer.
  
  
  METHODS
  A total of 402 consecutive patients with cancer of the esophagus or esophagogastric junction (181 adenocarcinoma [AC] and 221 squamous cell carcinoma [SCC]) (evaluated at clinical stage T1N1, T2N1, T3N0, or T3N1 and pathological stage M0) presenting in our Department between 1992 and 2007 and who underwent complete resection (R0) were included in this retrospective study on a prospectively collected database. All dissected lymph nodes were retrieved and microscopically analyzed. Nodal metastasis patterns in patients who underwent chemotherapy (CT) or chemoradiotherapy (CT-RT) neoadjuvant therapy were compared with those in patients who underwent surgery alone.
  
  
  RESULTS
  Almost 30% of the adenocarcinoma patients and approximately 40% of the SCC patients showed effective tumor downstaging after neoadjuvant therapy. There were fewer paracardial node metastases (P = .002) in the AC patients who underwent CT-RT neoadjuvant therapy. There were, likewise, significantly fewer paraesophageal, paracardial, and subcarinal node metastases in the SCC patients in whom the perigastric nodes became the second-most frequent site of metastasis.
  
  
  CONCLUSIONS
  Not only was frequency of lymph node metastases decreased after neoadjuvant therapy, but nodal localization and pattern were also significantly modified.
authors.affiliation: Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy. carlo.castoro@unipd.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Matteo
authors.initials: M
authors.lastname: Cagol
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruol
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Rita
authors.initials: R
authors.lastname: Alfieri
authors.forename: Gianpietro
authors.initials: G
authors.lastname: Zanchettin
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Ermanno
authors.initials: E
authors.lastname: Ancona
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil