title: Anatomic distribution of supraclavicular lymph node in patients with esophageal cancer.
abstract: OBJECTIVE
  Definitive chemoradiation therapy remains the standard of care for patients with localized esophageal carcinoma who choose nonsurgical management. However, there is no consensus regarding delineation of the nodal clinical target volume (CTVn), especially for lower cervical lymph nodes. This study aimed to map the location of metastatic supraclavicular lymph nodes in thoracic esophageal carcinoma patients with supraclavicular node involvement and generate an atlas to delineate the CTVn for elective nodal radiation of esophageal squamous cell carcinoma.
  
  
  METHODS
  In this study, the supraclavicular regional lymph node was further divided into four subgroups. The locations of the involved supraclavicular nodes for all patients were then transferred onto a template computed tomography (CT) image. A volume probability map was then generated with nodal volumes, and was displayed on the template CT to provide a visual impression of nodal frequencies and anatomic distribution.
  
  
  RESULTS
  We identified 154 supraclavicular nodal metastases based on CT image in 96 patients. Of these, 29.2% were located in group I region, 59.7% in group II region, 10.4% in group III region, and 0.7% in group IV region.
  
  
  CONCLUSIONS
  On the basis of our study, we suggest that the appropriate radiation field of CTVn should include the group I and II regions and the CTVn exterior margin along the lateral side of the internal jugular vein may be suitable.
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University.
authors.forename: Jun
authors.initials: J
authors.lastname: Xing
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University; School of Medical and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China.
authors.forename: Yijun
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University; School of Medical and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University.
authors.forename: Min
authors.initials: M
authors.lastname: Gao
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University.
authors.forename: Mingping
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University.
authors.forename: Xiuping
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University.
authors.forename: Tingyong
authors.initials: T
authors.lastname: Fan
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
keywords: cervical lymph node; clinical target volume; esophageal carcinoma; lymph node metastasis