title: [Radiochemotherapy for esophageal cancer: which nodes should be irradiated?].
abstract: Esophageal cancer has a high likelihood of distant lymphatic spread even at an early stage. Radiotherapy plays a major role in the management of localized or locally-advanced esophageal cancer with a regional or distant lymph node involvement. Radiotherapy can sterilize micrometastatic nodes and cancer cells in transit in the peri-esophageal fat that are not removed by surgery. After preoperative chemoradiotherapy followed by monobloc esophagectomy including lymph node dissection above and below the diaphragm, the locoregional failure rate was around 3% in the Chemoradiotherapy for Esophageal Cancer followed by Surgery Study Group (CROSS) trial. This is significantly lower than that observed with surgery alone or following exclusive chemoradiotherapy delivering 50 Gy over 5 weeks. Patterns of failure usually combine local and nodal failure. These results suggest that: (1) radiotherapy plays a major role in the management of micrometastatic nodes that are not removed by surgery; (2) the total dose of radiotherapy without surgery may be too low to control macroscopic disease. Better knowledge of regional failure sites and the enhancement of clinical practices through homogenized nodal radiotherapy could lead to a decrease in regional relapses, but at the expense of irradiated volumes greater than the macroscopic tumor volume. Intensity-modulated radiotherapy or volumetric modulated arctherapy makes it possible to increase mediastinal irradiated volumes while effectively protecting healthy tissues.
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; Laboratoire d'électronique et d'informatique de l'image (Le2I), CNRS U6306, université de Bourgogne, BP, 21078 Dijon cedex, France. Electronic address: gcrehange@cgfl.fr.
authors.forename: G
authors.initials: G
authors.lastname: Créhange
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
authors.forename: M
authors.initials: M
authors.lastname: Quivrin
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
authors.forename: N
authors.initials: N
authors.lastname: Vulquin
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
authors.forename: A-A
authors.initials: AA
authors.lastname: Serre
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: Maingon
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D006801:Humans; D008197:Lymph Node Excision; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000517:prevention & control / Q000532:radiotherapy*; D015337:Multicenter Studies as Topic; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000532:radiotherapy; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D047368:Tumor Burden
keywords: Cancer de l’œsophage; Elective nodal irradiation; Esophageal cancer; Irradiation prophylactique ganglionnaire; Nodal failures; Radiotherapy; Radiothérapie; Rechutes ganglionnaires; Target volumes; Volumes cibles