A qualitative synthesis of the evidence behind elective lymph node irradiation in oesophageal cancer

Lien Van De Voorde; Ruben T H M Larue; Madelon Pijls; Jeroen Buijsen; Esther G C Troost; Maaike Berbée; Meindert Sosef; Wouter van Elmpt; Marie-Céline Schraepen; Ben Vanneste; Michel Oelers; Philippe Lambin

doi:10.1016/j.radonc.2014.11.010

A qualitative synthesis of the evidence behind elective lymph node irradiation in oesophageal cancer

Lien Van De Voorde^*, Ruben T H M Larue, Madelon Pijls, Jeroen Buijsen, Esther G C Troost, Maaike Berbée, Meindert Sosef, Wouter van Elmpt, Marie-Céline Schraepen, Ben Vanneste, Michel Oelers, Philippe Lambin

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND AND PURPOSE: Oesophageal cancer is the sixth leading cause of cancer death worldwide and radiotherapy plays a prominent role in its treatment. The presence of lymph node (LN) metastasis has been demonstrated to be one of the most significant prognostic factors related to oesophageal cancer. The use of elective lymph node irradiation (ENI) is still a topic of persistent controversy. The conservative school is to irradiate positive lymph nodes only; the other school is to prophylactically irradiate the regional lymph node area according to different tumour sites. This review investigated the justification for including ENI in the treatment of patients with oesophageal cancer.

MATERIAL AND METHODS: We performed a systematic literature search to find surgical data about lymph node distribution depending on different tumour subgroups: early, cervical, thoracic and gastroesophageal junction cancer. Furthermore, we performed a qualitative assessment of recurrence patterns in patients treated with or without ENI to derive estimates of the potential area at risk for lymph node harvest.

RESULTS: We identified and reviewed 49 studies: 10 in early, 8 in cervical, 10 in thoracic and the remaining 21 in gastroesophageal junction cancer. In general, these studies were conclusive in incidence and location of pathologic lymph nodes for different subgroups. Data for lymph node recurrence patterns are scarce and contributed little to our review.

CONCLUSIONS: This review resulted in five recommendations for radiation oncologists in daily practice. We used the available evidence about metastatic lymph node distribution to develop a careful reasonable radiation protocol for the corresponding tumour subgroups.

Original language	English
Pages (from-to)	166-74
Number of pages	9
Journal	Radiotherapy and Oncology
Volume	113
Issue number	2
DOIs	https://doi.org/10.1016/j.radonc.2014.11.010
Publication status	Published - Nov 2014

Keywords

Carcinoma, Squamous Cell
Esophageal Neoplasms
Humans
Lymph Nodes
Lymphatic Metastasis
Neoplasm Recurrence, Local

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10.1016/j.radonc.2014.11.010

Cite this

Van De Voorde, L., Larue, R. T. H. M., Pijls, M., Buijsen, J., Troost, E. G. C., Berbée, M., Sosef, M., van Elmpt, W., Schraepen, M.-C., Vanneste, B., Oelers, M., & Lambin, P. (2014). A qualitative synthesis of the evidence behind elective lymph node irradiation in oesophageal cancer. Radiotherapy and Oncology, 113(2), 166-74. https://doi.org/10.1016/j.radonc.2014.11.010

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abstract = "BACKGROUND AND PURPOSE: Oesophageal cancer is the sixth leading cause of cancer death worldwide and radiotherapy plays a prominent role in its treatment. The presence of lymph node (LN) metastasis has been demonstrated to be one of the most significant prognostic factors related to oesophageal cancer. The use of elective lymph node irradiation (ENI) is still a topic of persistent controversy. The conservative school is to irradiate positive lymph nodes only; the other school is to prophylactically irradiate the regional lymph node area according to different tumour sites. This review investigated the justification for including ENI in the treatment of patients with oesophageal cancer.MATERIAL AND METHODS: We performed a systematic literature search to find surgical data about lymph node distribution depending on different tumour subgroups: early, cervical, thoracic and gastroesophageal junction cancer. Furthermore, we performed a qualitative assessment of recurrence patterns in patients treated with or without ENI to derive estimates of the potential area at risk for lymph node harvest.RESULTS: We identified and reviewed 49 studies: 10 in early, 8 in cervical, 10 in thoracic and the remaining 21 in gastroesophageal junction cancer. In general, these studies were conclusive in incidence and location of pathologic lymph nodes for different subgroups. Data for lymph node recurrence patterns are scarce and contributed little to our review.CONCLUSIONS: This review resulted in five recommendations for radiation oncologists in daily practice. We used the available evidence about metastatic lymph node distribution to develop a careful reasonable radiation protocol for the corresponding tumour subgroups.",

keywords = "Carcinoma, Squamous Cell, Esophageal Neoplasms, Humans, Lymph Nodes, Lymphatic Metastasis, Neoplasm Recurrence, Local",

author = "{Van De Voorde}, Lien and Larue, {Ruben T H M} and Madelon Pijls and Jeroen Buijsen and Troost, {Esther G C} and Maaike Berb{\'e}e and Meindert Sosef and {van Elmpt}, Wouter and Marie-C{\'e}line Schraepen and Ben Vanneste and Michel Oelers and Philippe Lambin",

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AU - Van De Voorde, Lien

AU - Larue, Ruben T H M

AU - Pijls, Madelon

AU - Buijsen, Jeroen

AU - Troost, Esther G C

AU - Berbée, Maaike

AU - Sosef, Meindert

AU - van Elmpt, Wouter

AU - Schraepen, Marie-Céline

AU - Vanneste, Ben

AU - Oelers, Michel

AU - Lambin, Philippe

PY - 2014/11

Y1 - 2014/11

N2 - BACKGROUND AND PURPOSE: Oesophageal cancer is the sixth leading cause of cancer death worldwide and radiotherapy plays a prominent role in its treatment. The presence of lymph node (LN) metastasis has been demonstrated to be one of the most significant prognostic factors related to oesophageal cancer. The use of elective lymph node irradiation (ENI) is still a topic of persistent controversy. The conservative school is to irradiate positive lymph nodes only; the other school is to prophylactically irradiate the regional lymph node area according to different tumour sites. This review investigated the justification for including ENI in the treatment of patients with oesophageal cancer.MATERIAL AND METHODS: We performed a systematic literature search to find surgical data about lymph node distribution depending on different tumour subgroups: early, cervical, thoracic and gastroesophageal junction cancer. Furthermore, we performed a qualitative assessment of recurrence patterns in patients treated with or without ENI to derive estimates of the potential area at risk for lymph node harvest.RESULTS: We identified and reviewed 49 studies: 10 in early, 8 in cervical, 10 in thoracic and the remaining 21 in gastroesophageal junction cancer. In general, these studies were conclusive in incidence and location of pathologic lymph nodes for different subgroups. Data for lymph node recurrence patterns are scarce and contributed little to our review.CONCLUSIONS: This review resulted in five recommendations for radiation oncologists in daily practice. We used the available evidence about metastatic lymph node distribution to develop a careful reasonable radiation protocol for the corresponding tumour subgroups.

AB - BACKGROUND AND PURPOSE: Oesophageal cancer is the sixth leading cause of cancer death worldwide and radiotherapy plays a prominent role in its treatment. The presence of lymph node (LN) metastasis has been demonstrated to be one of the most significant prognostic factors related to oesophageal cancer. The use of elective lymph node irradiation (ENI) is still a topic of persistent controversy. The conservative school is to irradiate positive lymph nodes only; the other school is to prophylactically irradiate the regional lymph node area according to different tumour sites. This review investigated the justification for including ENI in the treatment of patients with oesophageal cancer.MATERIAL AND METHODS: We performed a systematic literature search to find surgical data about lymph node distribution depending on different tumour subgroups: early, cervical, thoracic and gastroesophageal junction cancer. Furthermore, we performed a qualitative assessment of recurrence patterns in patients treated with or without ENI to derive estimates of the potential area at risk for lymph node harvest.RESULTS: We identified and reviewed 49 studies: 10 in early, 8 in cervical, 10 in thoracic and the remaining 21 in gastroesophageal junction cancer. In general, these studies were conclusive in incidence and location of pathologic lymph nodes for different subgroups. Data for lymph node recurrence patterns are scarce and contributed little to our review.CONCLUSIONS: This review resulted in five recommendations for radiation oncologists in daily practice. We used the available evidence about metastatic lymph node distribution to develop a careful reasonable radiation protocol for the corresponding tumour subgroups.

KW - Carcinoma, Squamous Cell

KW - Esophageal Neoplasms

KW - Humans

KW - Lymph Nodes

KW - Lymphatic Metastasis

KW - Neoplasm Recurrence, Local

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