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Objective:The efficacy of postoperative radiotherapy (RT) for esophageal carcinoma remains controversial.Therefore, the aim of this study was to identify patterns of relapse and relapse ratesfor stageT2-3N0M0 esophageal cancer following surgery and to determine a reasonable target for postoperative RT.Methods:A total of 3480 patients were retrospectively analyzed after receiving an initial diagnosis of esophageal squamous cell carcinoma between January 2004 and May 2009.Of the 581 patients with stageT2-3N0M0 tumors, 153 patients were stage T2N0 (26.3%) and 428 patients were stage T3N0 (73.7%).Furthermore, 543 patients underwent completeresection (S group) and 38 patients accepted intensity-modulated radiotherapy (IMRT)following complete resection (S+R group).Results: For the S group, the relapse rate was 43.6% for the T2N0 cases and 39.0% for the T3N0 cases (p =0.329).The relapse rates according to the upper, mid, and lower segments of the thoracic esophagus were 42.4%, 41.4%, and 36.1%, respectively (p=0.545).Overall, the relapse rate was 40.3% for the S group and 15.8% for the S+R group (p =0.003).The most frequent sites of relapse were the mediastinal and supraclavicular lymph nodes.The 5-y disease-free survival (DFS) rates were 50.8% and65.3%, respectively (p =0.044).A Cox regression model further revealed that patient age, upper tumor margin, presence of vascular invasion, and histological grade were independent prognostic factors for overall survival (OS), while upper tumor margin and vascular invasion were predictors for DFS.Conclusion:Themediastinallymph nodes, supraclavicular lymph nodes, and tumor bed were identified as optimal targetsfor postoperative RT.Furthermore, postoperative IMRT therapy was found to reduce the relapse rate and to improve DFS for stage pT3N0M0 patients.In particular, IMRT was important for pT2N0M0 esophageal carcinomas.