title: Celiac node failure patterns after definitive chemoradiation for esophageal cancer in the modern era.
abstract: OBJECTIVE
  The celiac lymph node axis acts as a gateway for metastatic systemic spread. The need for prophylactic celiac nodal coverage in chemoradiation therapy for esophageal cancer is controversial. Given the improved ability to evaluate lymph node status before treatment via positron emission tomography (PET) and endoscopic ultrasound, we hypothesized that prophylactic celiac node irradiation may not be needed for patients with localized esophageal carcinoma.
  
  
  METHODS
  We reviewed the radiation treatment volumes for 131 patients who underwent definitive chemoradiation for esophageal cancer. Patients with celiac lymph node involvement at baseline were excluded. Median radiation dose was 50.4 Gy. The location of all celiac node failures was compared with the radiation treatment plan to determine whether the failures occurred within or outside the radiation treatment field.
  
  
  RESULTS
  At a median follow-up time of 52.6 months (95% CI 46.1-56.7 months), 6 of 60 patients (10%) without celiac node coverage had celiac nodal failure; in 5 of these patients, the failures represented the first site of recurrence. Of the 71 patients who had celiac coverage, only 5 patients (7%) had celiac region relapse. In multivariate analyses, having a pretreatment-to-post-treatment change in standardized uptake value on PET >52% (odds ratio [OR] 0.198, p = 0.0327) and having failure in the clinical target volume (OR 10.72, p = 0.001) were associated with risk of celiac region relapse. Of those without celiac coverage, the 6 patients that later developed celiac failure had a worse median overall survival time compared with the other 54 patients who did not fail (median overall survival time: 16.5 months vs. 31.5 months, p = 0.041). Acute and late toxicities were similar in both groups.
  
  
  CONCLUSIONS
  Although celiac lymph node failures occur in approximately 1 of 10 patients, the lack of effective salvage treatments and subsequent low morbidity may justify prophylactic treatment in distal esophageal cancer patients.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Wayne
authors.initials: W
authors.lastname: Hofstetter
authors.forename: Christopher
authors.initials: C
authors.lastname: Crane
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: James
authors.initials: J
authors.lastname: Welsh
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes; D015182:Lymphatic Irradiation / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate