Esophageal carcinoma is one of the most difficult cancerous diseases to cure, despite the common use of multimodal therapy such as surgery, radiotherapy, and chemotherapy, and it has a poor prognosis [1, 2]. The reason for the poor prognosis is that most patients present with advanced stage disease, with the tumor metastasizing to the lymph nodes even in the early stages of the disease . It is characterized by extensive local growth, lymph node metastasis, and distant metastasis, and its spread is greatly affected by its vertical location because the esophagus is a long organ.
METHODS AND MATERIALS
Cases were reviewed of patients diagnosed with thoracoabdominal esophageal carcinoma who underwent curative surgery at Tenri Hospital between July 1986 and July 2007. Cases of pathological Stage IVB disease, according to the International Union Against Cancer (UICC) 2002 staging system , were excluded. Similarly, cases of unsuccess-ful curative resection were excluded. The remaining 117 cases were examined in this study.
All patients received curative surgery. Subtotal esophagectomy was performed in most patients, while middle-lower thoracic and abdominal esophagectomy was performed when small primary lesions were present in the lower thor-acic esophagus, when primary lesions were present in the abdominal esophagus or when gastrectomy was performed at the same time.
Median follow-up duration was 7.4 years (range, 0.1–16.6 years). Seven patients (6.0% of the total: 6 in the IORT group, 1 in the non-IORT group) were lost to follow-up before the end of the third year after treatment, which was determined as the final follow-up point. In addition, 9 patients (7.7% of the total: 7 in the IORT group, 2 in the non-IORT group) were lost to follow-up before the end of the fifth year after treatment.
The recurrence rate was 41.7% (30 patients) in the IORT group and 57.8% (26 patients) in the non-IORT group. The incidence of first recurrence in the upper abdominal lymph node area was lower in the IORT group (2.8%, 2 patients) than in the non-IORT group (13.3%, 6 patients). The incidence rates of other locoregional recurrence (including local recurrence and recurrence in the cervical lymph node area or mediastinal lymph node area) were not much different between the IORT group (18.1%, 13 patients) and the non-IORT group (20.0%, 9 patients).
In conclusion, albeit with some limitations, IORT targeted to the upper abdominal lymph node area is effective in obtaining good local control. It is also beneficial for treat-ing patients with lower thoracic or abdominal esophageal carcinoma and those with a long primary lesion, as it can improve survival rates in these patients. IORT shows promise as an effective treatment option for such patients.