title: Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation.
abstract: BACKGROUND
  To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV).
  
  
  METHODS
  A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution.
  
  
  RESULTS
  In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV.
  
  
  CONCLUSIONS
  According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas.
authors.affiliation: School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250117, China;; Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Yijun
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Liu
authors.affiliation: School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250117, China;; Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Dalian Medical University, Dalian 116001, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
authors.affiliation: School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250117, China;; Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Chengang
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
authors.forename: Minghuan
authors.initials: M
authors.lastname: Li
keywords: Esophageal cancer (EC); postoperative radiotherapy; supraclavicular region (SCV region); target volume definition