{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T07:13:07Z","timestamp":1760425987460,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T00:00:00Z","timestamp":1619395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The lower neck and upper mediastinum are the major regions for postoperative radiotherapy (PORT) in thoracic esophageal squamous cell carcinoma (TESCC). However, there is no uniform standard regarding the delineation of nodal clinical target volume (CTVnd). This study aimed to map the recurrent lymph nodes in the cervical and upper mediastinal regions and explore a reasonable CTVnd for PORT in TESCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed patients in our hospital with first cervical and\/or upper mediastinal lymph node recurrence (LNR) after upfront esophagectomy. All of these recurrent lymph nodes were plotted on template computed tomography (CT) images with reference to surrounding structures. The recurrence frequency at different stations was investigated and the anatomic distribution of recurrent lymph nodes was analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 119 patients with 215 recurrent lymph nodes were identified. There were 47 (39.5%) patients with cervical LNR and 102 (85.7%) patients with upper mediastinal LNR. The high-risk regions were station 101L\/R, station 104L\/R, station 106recL\/R, station 105 and station 106pre for upper TESCC and station 104L\/R, station 106recL\/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. LNR in the external group of station 104L\/R was not common, and LNR was not found in the narrow spaces where the trachea was in close contact with the innominate\u00a0artery, aortic arch and mediastinal pleura. LNR below the level of the cephalic margin of the superior vena cava was also not common for upper TESCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The CTVnd of PORT in the cervical and upper mediastinal regions should cover station 101L\/R, station 104L\/R, station 106recL\/R, station 105 and station 106pre for upper TESCC and station 104L\/R, station 106recL\/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. Based on our results, we proposed a useful atlas for guiding the delineation of CTVnd in TESCC.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2021.663679","type":"journal-article","created":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T07:29:02Z","timestamp":1619422142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Mapping of Cervical and Upper Mediastinal Lymph Node Recurrence for Guiding Clinical Target Delineation of Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma"],"prefix":"10.3389","volume":"11","author":[{"given":"Yichun","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongmei","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liyang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingwei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanli","family":"Xia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ningning","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangcun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)31462-9","article-title":"Oesophageal Cancer","volume":"390","author":"Lagergren","year":"2017","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05721-w","article-title":"The Efficacy of Neoadjuvant Versus Adjuvant Therapy for Resectable Esophageal Cancer Patients: A Systematic Review and Meta-Analysis","volume":"44","author":"Xiao","year":"2020","journal-title":"World J Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1112088","article-title":"Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer","volume":"366","author":"van Hagen","year":"2012","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(15)00040-6","article-title":"Neoadjuvant Chemoradiotherapy Plus Surgery Versus Surgery Alone for Oesophageal or Junctional Cancer (CROSS): Long-Term Results of a Randomised Controlled Trial","volume":"16","author":"Shapiro","year":"2015","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.S286074","article-title":"Postoperative Radiotherapy for Thoracic Esophageal Carcinoma With Upfront R0 Esophagectomy","volume":"12","author":"Wang","year":"2020","journal-title":"Cancer Manag Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1186\/s13014-018-1199-3","article-title":"Recommendation for the Definition of Postoperative Radiotherapy Target Volume Based on a Pooled Analysis of Patterns of Failure After Radical Surgery Among Patients With Thoracic Esophageal Squamous Cell Carcinoma","volume":"13","author":"Zhang","year":"2018","journal-title":"Radiat Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1186\/s12885-019-6065-7","article-title":"Mapping Patterns of Metastatic Lymph Nodes for Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma: A Recommendation for Clinical Target Volume Definition","volume":"19","author":"Yu","year":"2019","journal-title":"BMC Cancer"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2018.7807","article-title":"A Retrospective Study of Pattern of Recurrence After Radical Surgery for Thoracic Esophageal Carcinoma With or Without Postoperative Radiotherapy","volume":"15","author":"Wang","year":"2018","journal-title":"Oncol Lett"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.S249810","article-title":"Risk Factors and Patterns of Abdominal Lymph Node Recurrence After Radical Surgery for Locally Advanced Thoracic Esophageal Squamous Cell Cancer","volume":"12","author":"Wang","year":"2020","journal-title":"Cancer Manag Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.9094","article-title":"Determination of Radiotherapeutic Target Zones for Thoracic Esophageal Squamous Cell\u00a0Cancer With Lower Cervical Lymph Node Metastasis According to CT-Images","volume":"7","author":"Li","year":"2016","journal-title":"oncotarget"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14761","article-title":"Identification of Risk Factors and the\u2002Pattern of Lower Cervical Lymph Node Metastasis in Esophageal Cancer: Implications for Radiotherapy Target Delineation","volume":"8","author":"Luo","year":"2017","journal-title":"oncotarget"},{"key":"B12","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s10388-016-0556-2","article-title":"Japanese Classification of Esophageal Cancer, 11th Edition: Part II and III","volume":"14","year":"2017","journal-title":"Esophagus"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.06.024","article-title":"Atlas of the Thoracic Lymph Nodal Delineation and Recommendations for Lymph Nodal CTV of Esophageal Squamous Cell Cancer in Radiation Therapy From China","volume":"116","author":"Huang","year":"2015","journal-title":"Radiother Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.s182436","article-title":"Anatomy of Lymphatic Drainage of the Esophagus and Lymph Node Metastasis of Thoracic Esophageal Cancer","volume":"10","author":"Wang","year":"2018","journal-title":"Cancer Manag Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.3390\/cancers12061592","article-title":"Distribution of Lymph Node Metastases in Esophageal Carcinoma Patients Undergoing Upfront Surgery: A Systematic Review","volume":"12","author":"Hagens","year":"2020","journal-title":"Cancers (Basel)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/s12885-020-6592-2","article-title":"A phase-II\/III Randomized Controlled Trial of Adjuvant Radiotherapy or Concurrent Chemoradiotherapy After Surgery Versus Surgery Alone in Patients With stage-IIB\/III Esophageal Squamous Cell Carcinoma","volume":"20","author":"Ni","year":"2020","journal-title":"BMC Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0276","article-title":"Postoperative Radiotherapy in Pathological T2-3n0m0 Thoracic Esophageal Squamous Cell Carcinoma: Interim Report of a Prospective, Phase III, Randomized Controlled Study","volume":"25","author":"Deng","year":"2020","journal-title":"Oncologist"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-007-0257-6","article-title":"Extramural Lymphatic Drainage From the Thoracic Esophagus Based on Minute Cadaveric Dissections: Fundamentals for the Sentinel Node Navigation Surgery for the Thoracic Esophageal Cancers","volume":"29","author":"Saito","year":"2007","journal-title":"Surg Radiol Anat"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1679\/aohc.53.Suppl_219","article-title":"Topographical Anatomy of the Bronchomediastinal Lymph Vessels: Their Relationships and Formation of the Collecting Trunks","author":"Murakami","year":"1990","journal-title":"Arch Histol Cytol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-073X.2005.00114.x","article-title":"Anatomy and Histology of Virchow\u2019s Node","volume":"80","author":"Mizutani","year":"2005","journal-title":"Anat Sci Int"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-006-0115-y","article-title":"Anatomy of Right Recurrent Nerve Node: Why Does Early Metastasis of Esophageal Cancer Occur in it","volume":"28","author":"Mizutani","year":"2006","journal-title":"Surg Radiol Anat"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/s0360-3016(96)00425-7","article-title":"Optimal Size Criteria of Malignant Lymph Nodes in the Treatment Planning of Radiotherapy for Esophageal Cancer: Evaluation by Computed Tomography and Magnetic Resonance Imaging","volume":"36","author":"Mizowaki","year":"1996","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B23","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s12957-020-01880-1","article-title":"Evaluation of Metastatic Lymph Nodes in cN0 Thoracic Esophageal Cancer Patients With Inconsistent Pathological Lymph Node Diagnosis","volume":"18","author":"Wakita","year":"2020","journal-title":"World J Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/dote\/doy120","article-title":"Normal Radiological Lymph Node Appearance in the Thorax","volume":"32","author":"Hansen","year":"2019","journal-title":"Dis Esophagus"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.663679\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T07:29:04Z","timestamp":1619422144000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.663679\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,26]]},"references-count":24,"alternative-id":["10.3389\/fonc.2021.663679"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2021.663679","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2021,4,26]]},"article-number":"663679"}}