Abstract: Objective To evaluate the influence of gross tumor volume（GTV） ＞40 cm³ of mediastinal lymph nodes on the curative effect of patients with esophageal cancer receiving concurrent chemoradiotherapy after esophagectomy.
Methods From June 2010 to November 2012， sixty patients with GTV ＞40 cm³ of mediastinal lymph nodes were randomly assigned to receive three dimensional conformal radiotherapy （control group， n=30） and concurrent chemoradiotherapy （treatment group， n=30）. As for radiotherapy， the total radiation dose was 60-64 Gy at a fraction of 2 Gy with 5 f／week. Treatment group received paclitaxel and cisplatin （TP） regime additionally. Response to chemotherapy was assessed by RECIST criteria 1.1 and toxicity was evaluated according to RGOT standard. The clinical follow-up data from chemotherapy were investigated. Results All patients were available for evaluation. The total response rate （RR） and disease control rate （DCR） were 86.7％ and 100.0％ in treatment group， and 60.0％ and 96.7％ in control group. The RR of treatment group was higher than that of control group （P＜0.05）. No significant difference was observed on DCR between both groups （P＞0.05）. The median overall survival of the treatment group and the control group were 27.0 months and 22.0 months， respectively， and the difference was statistically significant （P＜0.05）. The 1-， 2- and 3-year survival rates were 90.0％， 53.3％ and 26.7％ in treatment group and 73.3％， 23.3％ and 6.7％ in control group， respectively. The difference of 3-year survival rate between both groups was statistically significance （P＜0.05）. The adverse reactions of the whole group were mainly of radioactive esophagitis， radiation pneumonia， gastrointestinal reaction and bone marrow suppression， all of which were 1-2 grade， and there was no 3-4 grade adverse reaction. There was no significant difference in adverse reactions between both groups （P＞0.05）. Conclusion Concurrent chemoradiotherapy improved the local control rate and survival rate for GTV＞40 cm³ of mediastinal lymph node metastasis after esophagectomy with mild and tolerated adverse reaction.