title: Supraclavicular node disease is not an independent prognostic factor for survival of esophageal cancer patients treated with definitive chemoradiation.
abstract: BACKGROUND
  The prognostic value of supraclavicular lymph node (SCN) metastases in esophageal cancer is not well established. We analyzed the prognostic value of SCN disease in patients after definitive chemoradiation (dCRT) for esophageal cancer.
  
  
  METHODS
  We retrospectively analyzed 207 patients treated between 2003 and 2013 to identify the prognostic value of metastasis in the SCN on treatment failure and survival. All patients were treated with external beam radiotherapy (50.4 Gy in 28 fractions) combined with weekly concurrent paclitaxel 50 mg/m2and carboplatin AUC2.
  
  
  RESULTS
  Median follow-up for patients alive was 43.3 months. The median overall survival (OS) for all patients was 17.5 months. OS at one, three and five years was 67%, 36% and 21%, respectively. For patients with metastasis in a SCN, OS was 23.6 months compared to 17.1 months for patients without metastasis in the SCN (p = .51). In multivariate analyses, higher cT status, cN status and adenocarcinoma were found to be prognostically unfavorable, but a positive SCN was not (p = .67). Median OS and median disease-free survival for tumors with SCN involvement and N0/1 disease was 49.0 months and 51.6 months, respectively, compared to 14.2 months and 8.2 months, respectively, in patients with N2/3 disease.
  
  
  CONCLUSIONS
  In esophageal cancer treated with dCRT, the number of affected lymph nodes is an important independent prognostic factor, whereas involvement of a SCN is not. Supraclavicular lymph nodes should be considered as regional lymph nodes and treated with curative intent if the total number of involved lymph nodes is limited.
authors.affiliation: a Department of Radiotherapy , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Jeene
authors.affiliation: a Department of Radiotherapy , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Versteijne
authors.affiliation: b Department of Surgery , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: c Department of Gastroenterology , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergmann
authors.affiliation: a Department of Radiotherapy , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Elisabeth D
authors.initials: ED
authors.lastname: Geijsen
authors.affiliation: d Department of Medical Oncology , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.affiliation: a Department of Radiotherapy , Academic Medical Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Maarten C C M
authors.initials: MC
authors.lastname: Hulshof
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy; D002968:Clavicle / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate