NCCN 2016第二版：可切除食管癌和不可切除食管癌

可切除的食管癌或胃食管結合部癌：

• T1N0；
• T1-3患者，即使N+仍有被切除的可能，即使體積大的、多站的淋巴結轉移是手術的相對禁忌症，但是需要結合年齡還有患者一般情況決定；
• T4a：侵犯心包、胸膜、膈肌。

不可切除的食管癌：

• T4b：侵犯心臟、大血管、氣管、肝、胰腺、肺、脾。
• 大多多站和大淋巴結轉移的患者應該視為不可切除，但是淋巴結情況還需要結合考慮患者的年齡、一般情況及治療反應情況；
• 胃食管結合部及鎖骨上淋巴結轉移被視為不可切除。
• 患者有遠處轉移（包括有非區域淋巴結轉移）

18：肝總動脈淋巴結，位於近端肝總動脈。

19：脾淋巴結位於近端脾動脈

18，19並非食管癌的區域淋巴結。

英文原版：

? Resectable esophageal or EGJ cancer:

T1a tumors, defined as tumors involving the mucosa but not invading the submucosa, may be considered for EMR + ablation or esophagectomy in experienced centers. 6-10

Tumors in the submucosa (T1b) or deeper may be treated with esophagectomy.

T1-T3 tumors are resectable even with regional nodal metastases (N+), although bulky, multi-station lymphatic involvement is a relative contraindication to surgery, to be considered in conjunction with age and performance status.

T4a tumors with involvement of pericardium, pleura, or diaphragm are resectable.

? Unresectable esophageal cancer:

cT4b tumors with involvement of the heart, great vessels, trachea, or adjacent organs including liver, pancreas, lung, and spleen are unresectable.

Most patients with multi-station, bulky lymphadenopathy should be considered unresectable, although lymph node involvement should be considered in conjunction with other factors, including age and performance status and response to therapy.

Patients with EGJ and supraclavicular lymph node involvement should be considered unresectable.

Patients with distant (including nonregional lymph nodes) metastases (stage IV) are unresectable.

放療專業信息公眾：RadiationOncology

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