Analysis of Therapeutic Effect and Prognosis of Radiotherapy for Patients with Esophageal Carcinoma with Supraclavicular Lymph Node Metastasis

Objective To explore the factors affecting the prognosis of radiotherapy for esophageal carcinoma with supraclavicular lymph node metastasis. Methods One hundred and fifty-two esophageal carcinoma patients with supraclavicular lymph node metastases who were admitted to the Fourth Hospital of Hebei Medical University from January 2005 to December 2009 were enrolled.A total of 95 patients with primary tumors received radiotherapy,whereas 57 patients underwent surgery.Eighty one patients were found supraclavicular lymph nodes metastasis after the treatment of primary esophageal carcinoma,and 71 patients were found with metastasis when they were diagnosed.A total of 141 patients with supraclavicular lymph node metastasis received radiotherapy,whereas 11 did not. Results Follow-up time was 2 to 77 months with a median follow-up time of 17.5 months.After radiotherapy for the supraclavicular lymph-node,the rate of CR,PR,NR and PD was 52.5%,41.8%,3.6% and 2.1% respectively.The 1-,2-,3-year overall survival rates were 51.3%,26.6% and 17.3%.The 1-year survival rates for one-side and both sides were 54.0% and 26.7%,and the 3-year survival rates were 17.6% and 13.3% (P=0.033).The 1-,3-year survival rates of patients with supraclavicular lymph nodes metastasis subjected the dose more than 60 Gy were 61.5%,21.7%,and that of less than 60 Gy were 12.5%,0% (P<0.01),respectively.The 1-,3-year survival rates of patients with contralateral supraclavicular prophylactic irradiation were 53.7%,12.3%,and that of without prophylactic irradiation were 56.3%,20.6 % (P=0.939),respectively.Multivariate analysis revealed that age,time of supraclavicular lymphnode metastasis,whether the primary tumors were controlled and visceral metastasis were independent factors for the survivals (P=0.007,0.009,0.008,<0.01). Conclusion The patients of esophageal carcinoma with supraclavicular lymph node metastasis can benefit from radiotherapy.The suitable dose of supraclavicular lymph node was 60～70 Gy.Prophylactic irradiation of contralateral supraclavicular region showed no advantage in prognosis.Age,the time of supraclavicular lymph nodes enlargement with primary esophageal carcinoma,status of the primary tumor and visceral metastasis were independent factors for the survival.