title: [Are extensive fields useful for radiotherapy of esophageal cancer?].
abstract: OBJECTIVE
  Study of the pattern of relapse for locally advanced oesophageal cancer and analysis of the local recurrences according to irradiated volume.
  
  
  METHODS
  We performed a monocentric retrospective study of patients treated in the integrated centre of oncology (Angers, France). Two treatment strategies were used: concurrent chemoradiation alone or followed by surgery. Recurrences were classified as: locoregional, either isolated or associated with distant metastasis, and metastatic only. Locoregional relapses were subclassified as in-field, out-field, or mixed.
  
  
  RESULTS
  Between March 2004 and October 2011, 168 patients were treated: 130 by chemoradiation, and 38 by chemoradiation followed by surgery. The median supero-inferior margins added to the gross tumour volume in order to create the planning tumour volume was 5cm (range: 0.5-21). Sixty-two percent of patients (n=104) relapsed: 82 locoregional relapses (49%), including 45 isolated relapses (27%) and 37 associated with distant metastasis relapses (22%), and 22 metastatic relapses (13%). From the 82 locoregional relapses, only four isolated relapses were exclusively out-field.
  
  
  CONCLUSIONS
  With 5cm supero-inferior margins added to gross tumour volume, less than 3% of patients had an isolated out-field recurrence. However, half of the patients suffered in-field local recurrence and one third had metastases. These findings advocate for a limited prophylactic nodal irradiation. Trials are ongoing to assess dose escalation or surgery in order to increase local control.
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Peyraga
authors.affiliation: Service d'oncologie médicale, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: O
authors.initials: O
authors.lastname: Capitain
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: D
authors.initials: D
authors.lastname: Rousseau
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Rio
authors.affiliation: Département de recherche clinique, institut cancérologique de l'Ouest, 2, rue Moll, 49000 Angers, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Septans
authors.affiliation: Service de chirurgie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: O
authors.initials: O
authors.lastname: Baton
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Marquis
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: P
authors.initials: P
authors.lastname: Trémolières
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France.
authors.forename: P
authors.initials: P
authors.lastname: Gustin
authors.affiliation: Service d'hépatogastroentérologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France.
authors.forename: É
authors.initials: É
authors.lastname: Ménager
authors.affiliation: Service de chirurgie viscérale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France.
authors.forename: F
authors.initials: F
authors.lastname: Branger
authors.affiliation: Service de chirurgie, clinique de l'Anjou, 9, rue de l'Hirondelle, 49000 Angers, France.
authors.forename: M
authors.initials: M
authors.lastname: Bressolette
authors.affiliation: Service de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: É
authors.initials: É
authors.lastname: Deutsch
authors.affiliation: Service de radiothérapie, institut cancérologique de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France. Electronic address: amaury.paumier@ico.unicancer.fr.
authors.forename: A
authors.initials: A
authors.lastname: Paumier
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies
keywords: Cancer de l’œsophage; Chirurgie; Clinical target volume; Oesophageal cancer; Pattern of relapse; Radiotherapy; Radiothérapie; Sites de rechutes; Surgery; Volume cible