The current recommendations for radiotherapy volume in adenocarcinoma of the gastroesophageal junction (AGE) have largely based on studies of surgical lymph node involvement due to minimal data on specific recurrent sites. We investigated the frequency and location of regional recurrence of AGE patients after curative resection to refine the clinical target volume (CTV) delineation of radiotherapy.
From 2009 to 2013, we retrospectively reviewed 1140 esophagogastric cancer patients treated in our institute. Patients who received curative resection with histopathological diagnosis of AGE, and were confirmed of regional recurrence in follow-up CT images were entered into analysis. First regional recurrence were recorded and one diagnostic radiologist with specialty of gastrointestinal tract investigated. The frequency and location of regional failure at each node station were analyzed according to Siewert types. We drew the recurrence sites at the equivalent location based on the same vessels of reference comparing CT images to recurrence CT images.
Regional recurrence was identified in 78 patients, among which 35 (44.9%) patients were regional nodule failure (NF) only, 24 (38%) experienced regional NF simultaneous with distant failure, 11 (14.1%) were locoregional, and 8(10.3%) had both distant and locoreginal failure. The most commonly involved first recurrent lymph nodes were Nodes No.16(62.8%), No. 9(32.1%), No. 11(24.4%), Nodes No. 8 (17.9%), No. 7(16.7%), No. 112(12.8%), No. 4(12.8%) and No. 12(10.3%), respectively. 11 patients (14.1%) had mediastinal lymph node metastasis. A three-dimensional (3D) atlas based on vessel delineation and distribution of corresponding regional recurrence were established according to Siewert types.
The most prevalent nodal recurrence in patients with AEG after curative resection was along the abdominal aorta, celiac artery and splenic artery. Our findings suggest that the current recommendation for lymph node target volume of AEG patients should be extended to the above vessels basin.
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All authors have declared no conflicts of interest.