title: Precise delineation of clinical target volume for crossing-segments thoracic esophageal squamous cell carcinoma based on the pattern of lymph node metastases.
abstract: BACKGROUND
  This work aims to investigate lymph node metastases (LNM) pattern of crossing-segments thoracic esophageal squamous cell carcinoma (ESCC) and its significance in clinical target volume (CTV) delineation.
  
  
  METHODS
  From January 2000 to December 2014, 3,587 patients with thoracic ESCC underwent surgery including esophagectomy and lymphadenectomy at Shandong Cancer Hospital and Institute. Information of tumor location based on preoperative endoscopic ultrasonography (EUS) and postoperative pathological results were retrospectively collected. The extent of the irradiation field was determined based on LNM pattern.
  
  
  RESULTS
  Among the patients reviewed, 1,501 (41.8%) were crossing-segments thoracic ESCC patients. The rate of LNM were 12.1%, 15.2%, 8.0%, 3.0%, and 7.1% in neck, upper mediastinum, middle mediastinum, lower mediastinum, and abdominal cavity for patients with upper-middle thoracic ESCC, 10.3%, 8.2%, 11.0%, 4.8%, 8.2% for middle-upper thoracic ESCC, 4.8%, 4.8%, 24.1%, 6.3%, 22.8% for middle-lower thoracic ESCC and 3.9%, 3.1%, 22.8%, 11.9%, 25.8% for lower-middle thoracic ESCC, respectively. The top three sites of LNM were 105 (12.1%), 108 (6.1%), 101 (6.1%) for upper-middle thoracic ESCC, 108 (8.2%), 105 (7.5%), 106 (6.8%) for middle-upper thoracic ESCC, 1 (18.8%), 108 (17.9%), 107 (9.6%) for middle-lower thoracic ESCC, 1 (21.3%), 108 (16.1%), 107 (10.1%) for lower-middle thoracic ESCC.
  
  
  CONCLUSIONS
  Crossing-segments thoracic ESCC was remarkably common among patients. When delineating their CTV, tumor location should be taken into consideration seriously. For upper-middle and middle-upper thoracic ESCC, abdominal cavity may be free from irradiation. For middle-lower and lower-middle thoracic ESCC, besides irradiation of relative mediastinal, irradiation of abdominal cavity can't be neglected.
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Dong
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Guan
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Zicheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Dongbo
authors.initials: D
authors.lastname: Zhao
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
authors.affiliation: 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Baosheng
authors.initials: B
authors.lastname: Li
keywords: Esophageal cancer; lymph node metastasis (LNM); radiotherapy