Atlas of the thoracic lymph nodal delineation and recommendations for lymph nodal CTV of esophageal squamous cell cancer in radiation therapy from China

Radiother Oncol. 2015 Jul;116(1):100-6. doi: 10.1016/j.radonc.2015.06.024. Epub 2015 Jun 30.


Purpose: To construct an anatomical atlas of thoracic lymph node regions of esophageal cancer (EC) based on definitions from The Japan Esophageal Society (JES) and generate a consensus to delineate the nodal clinical target volume (CTVn) for elective nodal radiation (ENI) of esophageal squamous cell carcinoma (ESCC).

Methods and materials: An interdisciplinary group including two dedicated radiation oncologists, an experienced radiologist, a pathologist and two thoracic surgeons were gathered to generate a three-dimensional radiological description for the mediastinal lymph node regions of EC on axial CT scans. Then the radiological boundaries of lymph node regions were validated by a relatively large number of physicians in multiple institutions.

Results: An atlas of detailed anatomic boundaries of lymph node station No. 105-114 was defined on axial CT, along with illustrations. From the previous work, the study provided a guide of CTVn contouring for ENI of thoracic ESCC from a single center.

Conclusion: It is feasible to use such an atlas of thoracic lymph node stations for radiotherapy planning. A phase III study based on the atlas is ongoing in China to measure quantitatively the ENI received by patients with ESCC.

Keywords: Computed tomography; Esophageal cancer; Lymph nodes; Radiation therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / radiotherapy*
  • Humans
  • Lymph Nodes / pathology*
  • Mediastinum / pathology
  • Tomography, X-Ray Computed