The significance of preoperative radiotherapy for esophageal cancer

Preoperative radiotherapy is not routine for patients with esophageal cancer who are suitable for surgery. However, patients with advanced local lesions who are difficult to operate on should receive preoperative radiotherapy because preoperative radiotherapy:

① It can improve the surgical resection rate, and its radiotherapy effect can shrink the tumor and reduce the lymph node metastasis rate;

②Does not increase the surgical mortality rate and the incidence of anastomotic leakage;

③ It can improve the survival rate and reduce the incidence of anastomotic stump cancer. In addition, if the pathology shows severe radiotherapy reaction after radiotherapy, the 5-year survival rate is significantly better than that of moderate or mild radiotherapy reaction.

Scope of preoperative radiotherapy

The proportion of lymph node metastasis found during surgery is about 50%, and preoperative radiotherapy can reduce the rate of lymph node metastasis. The site and proportion of lymph node metastasis are related to the degree of surgical lymph node dissection, the scope of dissection and the site of the primary lesion. Therefore, preoperative radiotherapy should include the corresponding lymph node drainage area. Preoperative radiotherapy for cervical and upper esophageal cancer is recommended to include the supraclavicular area and the middle and lower mediastinum, because the supraclavicular lymph node metastasis rate can be as high as 46.3% when the above three-field lymph node dissection is found; when preoperative radiotherapy for lower esophageal cancer, the focus should be on including the subdiaphragmatic lymph nodes, i.e., the left gastric cardia, because at least 1/2 of the patients have subdiaphragmatic lymph node metastasis.

The width of the irradiation field is usually 6 to 6.5 cm, with front-to-back irradiation.

Radiation dose: Although the severe radiation response rate is high when the preoperative radiotherapy tumor dose reaches 50Gy, its 5-year survival rate does not increase. The main reason is the high surgical complications. Therefore, the recommended tumor dose for preoperative radiotherapy of middle and lower esophageal cancer is 40Gy. The radiotherapy dose for cervical or upper esophageal cancer can reach 50Gy.