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. 2021 Jan;18(1):100-110.
doi: 10.1007/s10388-020-00777-y. Epub 2020 Sep 5.

Lymph node response to chemoradiotherapy in oesophageal cancer patients: relationship with radiotherapy fields

Willem J Koemans  1   2   3 , Ruben T H M Larue  4   5 , Maximilian Kloft  2 , Jessica E Ruisch  2 , Inge Compter  4 , Robert G Riedl  6 , Lara R Heij  7   8 , Wouter van Elmpt  4 , Maaike Berbée  4 , Jeroen Buijsen  4 , Philippe Lambin  5 , Meindert N Sosef  1 , Heike I Grabsch  9   10
Affiliations

Lymph node response to chemoradiotherapy in oesophageal cancer patients: relationship with radiotherapy fields

Willem J Koemans et al. Esophagus. 2021 Jan.

Abstract

Background: The presence of lymph node metastasis (LNmets) is a poor prognostic factor in oesophageal cancer (OeC) patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery. Tumour regression grade (TRG) in LNmets has been suggested as a predictor for survival. The aim of this study was to investigate whether TRG in LNmets is related to their location within the radiotherapy (RT) field.

Methods: Histopathological TRG was retrospectively classified in 2565 lymph nodes (LNs) from 117 OeC patients treated with nCRT and surgery as: (A) no tumour, no signs of regression; (B) tumour without regression; (C) viable tumour and regression; and (D) complete response. Multivariate survival analysis was used to investigate the relationship between LN location within the RT field, pathological TRG of the LN and TRG of the primary tumour.

Results: In 63 (54%) patients, viable tumour cells or signs of regression were seen in 264 (10.2%) LNs which were classified as TRG-B (n = 56), C (n = 104) or D (n = 104) LNs. 73% of B, C and D LNs were located within the RT field. There was a trend towards a relationship between LN response and anatomical LN location with respect to the RT field (p = 0.052). Multivariate analysis showed that only the presence of LNmets within the RT field with TRG-B is related to poor overall survival.

Conclusion: Patients have the best survival if all LNmets show tumour regression, even if LNmets are located outside the RT field. Response in LNmets to nCRT is heterogeneous which warrants further studies to better understand underlying mechanisms.

Keywords: Lymph node regression; Neoadjuvant chemoradiotherapy; Oesophageal cancer; Radiation field.

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Conflict of interest statement

All authors declare to have no conflict of interest.

Figures

Fig. 1
Fig. 1
a ‘True-negative’ LN without evidence of tumour or tumour regression. b LN with viable tumour no regression (class B), c LN with viable tumour (circled) and regression (class C), d LN with regression no viable tumour (class D)
Fig. 2
Fig. 2
Kaplan–Meier curve showing that overall survival for ypN0 patients and LN responders differs significantly from LN non-responders
Fig. 3
Fig. 3
Dose distribution of a representative patient with a cT3N2M0 adenocarcinoma in the gastroesophageal junction. In the resected specimen a lymph node with complete regression was detected in the left upper paratracheal region (2L), indicated in orange
Fig. 4
Fig. 4
Bar charts showing the distribution of a LN TRG with respect to the RT-field location, and b LN RT-field location with respect to LN TRG
Fig. 5
Fig. 5
Kaplan–Meier curves for incomplete LN responders, stratified by the number of TRG-B LNs located within the RT-field (no TRG-B nodes versus ≥ 1 TRG-B nodes)
See this image and copyright information in PMC

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