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Title: Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma

Abstract

Purpose: To clarify the radiotherapy clinical target volume (CTV) margin needed for esophageal squamous-cell carcinoma (SCC) and gastroesophageal junction (GEJ) adenocarcinoma. Methods and Materials: Surgical specimens of esophageal SCC (n = 34) and GEJ adenocarcinoma (n = 32) were prospectively collected and analyzed for microscopic spread along the esophagus and GEJ both proximally and distally from gross tumor and for lymph node (LN) metastasis. Results: For SCC, the mean microscopic spread beyond the gross tumor was 10.5 {+-} 13.5 mm proximally (<30 mm in 32 of 34 cases) and 10.6 {+-} 8.1 mm distally (<30 mm in 33 of 34 cases). For GEJ adenocarcinoma, the spread was 10.3 {+-} 7.2 mm proximally (<30 mm in 29 of 29 cases) and 18.3 {+-} 16.3 mm distally (<30 mm in 27 of 32 cases). The extent of microscopic spread of cancer was significantly associated with pathologic T stage (p = 0.012). LN metastases were observed in 12 (35%) of 34 patients with middle and lower esophageal SCC and 15 (47%) of 32 patients with GEJ adenocarcinoma. Conclusions: The extent of microscopic spread within esophagus (recommended CTV margin) was <30 mm in about 94% of cases of esophageal cancer, except for distal microscopicmore » spread in GEJ adenocarcinoma, in which 50 mm was needed to cover about 94% of cases.« less

Authors:
 [1];  [2];  [3];  [3];  [3];  [4];  [5];  [5];  [5];  [6];  [7];  [8]
  1. Department of Radiation Oncology, Beijing University First Hospital, Beijing (China)
  2. (China)
  3. Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang (China)
  4. Department of Thoracic Surgery, Hebei Medical University Fourth Hospital, Shijiazhuang (China)
  5. Department of Pathology, Hebei Medical University Fourth Hospital, Shijiazhuang (China)
  6. Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
  7. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
  8. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States). E-mail: jychang@mdanderson.org
Publication Date:
OSTI Identifier:
20944678
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2006.09.015; PII: S0360-3016(06)02986-5; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; ESOPHAGUS; LYMPH NODES; METASTASES; PATIENTS; RADIOTHERAPY; SURGERY

Citation Formats

Gao Xianshu, Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang, Qiao Xueying, Wu Fengpeng, Cao Li, Meng Xianli, Dong Zhiming, Wang Xiaoling, Gao Guodong, Wu, T.-T., Komaki, Ritsuko, and Chang, Joe Y.. Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma. United States: N. p., 2007. Web.
Gao Xianshu, Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang, Qiao Xueying, Wu Fengpeng, Cao Li, Meng Xianli, Dong Zhiming, Wang Xiaoling, Gao Guodong, Wu, T.-T., Komaki, Ritsuko, & Chang, Joe Y.. Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma. United States.
Gao Xianshu, Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang, Qiao Xueying, Wu Fengpeng, Cao Li, Meng Xianli, Dong Zhiming, Wang Xiaoling, Gao Guodong, Wu, T.-T., Komaki, Ritsuko, and Chang, Joe Y.. Thu . "Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma". United States. doi:.
@article{osti_20944678,
title = {Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma},
author = {Gao Xianshu and Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang and Qiao Xueying and Wu Fengpeng and Cao Li and Meng Xianli and Dong Zhiming and Wang Xiaoling and Gao Guodong and Wu, T.-T. and Komaki, Ritsuko and Chang, Joe Y.},
abstractNote = {Purpose: To clarify the radiotherapy clinical target volume (CTV) margin needed for esophageal squamous-cell carcinoma (SCC) and gastroesophageal junction (GEJ) adenocarcinoma. Methods and Materials: Surgical specimens of esophageal SCC (n = 34) and GEJ adenocarcinoma (n = 32) were prospectively collected and analyzed for microscopic spread along the esophagus and GEJ both proximally and distally from gross tumor and for lymph node (LN) metastasis. Results: For SCC, the mean microscopic spread beyond the gross tumor was 10.5 {+-} 13.5 mm proximally (<30 mm in 32 of 34 cases) and 10.6 {+-} 8.1 mm distally (<30 mm in 33 of 34 cases). For GEJ adenocarcinoma, the spread was 10.3 {+-} 7.2 mm proximally (<30 mm in 29 of 29 cases) and 18.3 {+-} 16.3 mm distally (<30 mm in 27 of 32 cases). The extent of microscopic spread of cancer was significantly associated with pathologic T stage (p = 0.012). LN metastases were observed in 12 (35%) of 34 patients with middle and lower esophageal SCC and 15 (47%) of 32 patients with GEJ adenocarcinoma. Conclusions: The extent of microscopic spread within esophagus (recommended CTV margin) was <30 mm in about 94% of cases of esophageal cancer, except for distal microscopic spread in GEJ adenocarcinoma, in which 50 mm was needed to cover about 94% of cases.},
doi = {},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 67,
place = {United States},
year = {Thu Feb 01 00:00:00 EST 2007},
month = {Thu Feb 01 00:00:00 EST 2007}
}
  • Purpose: To compare and analyze the effect of different clinical target volumes (CTVs) on survival rate after postoperative radiotherapy (RT) for esophageal squamous cell carcinoma (SCC). Methods and Materials: We studied 102 patients who underwent postoperative RT after radical resection for esophageal SCC (T3/4 or N1). The radiation dose was {>=}50 Gy. In the extensive portal group (E group, 43 patients), the CTV encompassed the bilateral supraclavicular region, all mediastinal lymph nodes, the anastomosis site, and the left gastric and pericardial lymphatic. In the regional portal group (R group, 59 patients), the CTV was confined to tumor bed and themore » lymph nodes in the immediate region of the primary lesion. The 1-, 3-, and 5-year survival rates were compared between the groups, and multivariate/univariate analysis for factors predicting survival was studied. Results: For the entire group, the 1-, 3- and 5-year survival rates were 76.3%, 50.5%, and 42.9%, respectively (median survival, 30 months). The 1-, 3-, and 5-year survival rates were 76.5%, 52.1%, and 41.3%, respectively, in the E group and 76.2%, 49.2%, and 44.6%, respectively, in the R group (not significant). According to the multivariate analysis, N stage, number of lymph nodes with metastatic disease, and tumor length were the independent prognostic factors for survival. Conclusions: Using a regional portal in postoperative RT for esophageal SCC is not associated with compromised survival compared with extensive portal RT and therefore should be considered. N stage, number of affected lymph nodes, and tumor length predict poor survival.« less
  • Purpose: To compare elective nodal irradiation with involved-field irradiation for three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in patients with esophageal cancer by a metaanalysis. Methods: Wanfang, CNKI, VIP, CBM databases, PubMed, Embase and Cochrane Library were searched to identify the controlled clinical trials of elective nodal irradiation with involved-field irradiation for three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in patients with esophageal cancer. The obtained data were analyzed using Stata 11.0. The difference between two groups was estimated by calculating the odds ratio (OR) with 95% confidence interval (95% CI). Results: A total of 12 controlled clinical trials involving 1095 esophagealmore » cancer patients, which were selected according to inclusion and exclusion criteria, were included in this meta-analysis. The meta-analysis showed that the elective nodal irradiation group reduced the rates of out-field failure comparing with involved-field irradiation group (OR=3.727, P=0.007). However, the rates of ‚Č•grades 3 acute radiation pneumonitis and esophagitis were significantly higher in the elective nodal irradiation group than in the involved-field irradiation group (OR=0.348, P=0.001, OR=0.385, P=0.000). 1-, 2-, 3-year local control rates (OR=0.966, P=0.837, OR=0.946, P=0.781; OR=0.732P=0.098) and 1-, 3-, 5-year survival rates were similar in the two groups ( OR=0.966, P=0.837; OR=0.946, P=0.781; OR=0.732, P=0.098; OR=0.952, P=0.756; OR=1.149, P=0.422; OR=0.768, P=0.120). It is the same with the rates of distant metastasis (OR=0.986, P=0.937). Conclusion: Compared with involved-field irradiation, the elective nodal irradiation can reduce the rates of out-field failure for three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in patients with esophageal cancer. However, its advantage of local control and survival rates is not obvious and it increases the incidence of toxicities.« less
  • Purpose: We compared two treatment planning methods for stereotactic boost for treating nasopharyngeal carcinoma (NPC): the use of conventional whole-body bismuth germanate (BGO) scintillator positron emission tomography (PET{sub CONV}WB) versus the new brain (BR) PET system using semiconductor detectors (PET{sub NEW}BR). Methods and Materials: Twelve patients with NPC were enrolled in this study. [{sup 18}F]Fluorodeoxyglucose-PET images were acquired using both the PET{sub NEW}BR and the PET{sub CONV}WB system on the same day. Computed tomography (CT) and two PET data sets were transferred to a treatment planning system, and the PET{sub CONV}WB and PET{sub NEW}BR images were coregistered with the samemore » set of CT images. Window width and level values for all PET images were fixed at 3000 and 300, respectively. The gross tumor volume (GTV) was visually delineated on PET images by using either PET{sub CONV}WB (GTV{sub CONV}) images or PET{sub NEW}BR (GTV{sub NEW}) images. Assuming a stereotactic radiotherapy boost of 7 ports, the prescribed dose delivered to 95% of the planning target volume (PTV) was set to 2000 cGy in 4 fractions. Results: The average absolute volume ({+-}standard deviation [SD]) of GTV{sub NEW} was 15.7 ml ({+-}9.9) ml, and that of GTV{sub CONV} was 34.0 ({+-}20.5) ml. The average GTV{sub NEW} was significantly smaller than that of GTV{sub CONV} (p = 0.0006). There was no statistically significant difference between the maximum dose (p = 0.0585) and the mean dose (p = 0.2748) of PTV. The radiotherapy treatment plan based on the new gross tumor volume (PLAN{sub NEW}) significantly reduced maximum doses to the cerebrum and cerebellum (p = 0.0418) and to brain stem (p = 0.0041). Conclusion: Results of the present study suggest that the new brain PET system using semiconductor detectors can provide more accurate tumor delineation than the conventional whole-body BGO PET system and may be an important tool for functional and molecular radiotherapy treatment planning.« less
  • Purpose: To investigate dose-volume consequences of inclusion of the seminal vesicle (SV) bed in the clinical target volume (CTV) for the rectum and bladder using biological response indices in postprostatectomy patients receiving intensity-modulated radiotherapy (IMRT). Methods and Materials: We studied 10 consecutive patients who underwent prostatectomy for prostate cancer and subsequently received adjuvant or salvage RT to the prostate fossa. The CTV to planning target volume (PTV) expansion was 7 mm, except posterior expansion, which was 5 mm. Two IMRT plans were generated for each patient, including either the prostate fossa alone or the prostate fossa with the SV bed,more » but identical in all other aspects. Prescription dose was 68.4 Gy in 1.8-Gy fractions prescribed to {>=}95% PTV. Results: With inclusion of the SV bed in the treatment volume, PTV increased and correlated with PTV-bladder and PTV-rectum volume overlap (Spearman {rho} 0.91 and 0.86, respectively; p < 0.05). As a result, the dose delivered to the bladder and rectum was higher (p < 0.05): mean bladder dose increased from 11.3 {+-} 3.5 Gy to 21.2 {+-} 6.6 Gy, whereas mean rectal dose increased from 25.8 {+-} 5.5 Gy to 32.3 {+-} 5.5 Gy. Bladder and rectal equivalent uniform dose correlated with mean bladder and rectal dose. Inclusion of the SV bed in the treatment volume increased rectal normal tissue complication probability from 2.4% to 4.8% (p < 0.01). Conclusions: Inclusion of the SV bed in the CTV in postprostatectomy patients receiving IMRT increases bladder and rectal dose, as well as rectal normal tissue complication probability. The magnitude of PTV-bladder and PTV-rectal volume overlap and subsequent bladder and rectum dose increase will be higher if larger PTV expansion margins are used.« less
  • Purpose: To investigate the clinical factors independently predictive of long-term severe urinary sequelae after postprostatectomy radiotherapy. Patients and Methods: Between 1993 and 2005, 742 consecutive patients underwent postoperative radiotherapy with either adjuvant (n = 556; median radiation dose, 70.2 Gy) or salvage (n = 186; median radiation dose, 72 Gy) intent. Results: After a median follow-up of 99 months, the 8-year risk of Grade 2 or greater and Grade 3 late urinary toxicity was almost identical (23.9% vs. 23.7% and 12% vs. 10%) in the adjuvant and salvage cohorts, respectively. On univariate analysis, acute toxicity was significantly predictive of latemore » Grade 2 or greater sequelae in both subgroups (p <.0001 in both cases), and hypertension (p = .02) and whole-pelvis radiotherapy (p = .02) correlated significantly in the adjuvant cohort only. The variables predictive of late Grade 3 sequelae were acute Grade 2 or greater toxicity in both groups and whole-pelvis radiotherapy (8-year risk of Grade 3 events, 21% vs. 11%, p = .007), hypertension (8-year risk, 18% vs. 10%, p = .005), age {<=} 62 years at RT (8-year risk, 16% vs. 11%, p = .04) in the adjuvant subset, and radiation dose >72 Gy (8-year risk, 19% vs. 6%, p = .007) and age >71 years (8-year risk, 16% vs. 6%, p = .006) in the salvage subgroup. Multivariate analysis confirmed the independent predictive role of all the covariates indicated as statistically significant on univariate analysis. Conclusions: The risk of late Grade 2 or greater and Grade 3 urinary toxicity was almost identical, regardless of the RT intent. In the salvage cohort, older age and greater radiation doses resulted in a worse toxicity profile, and younger, hypertensive patients experienced a greater rate of severe late sequelae in the adjuvant setting. The causes of this latter correlation and apparently different etiopathogenesis of chronic damage in the two subgroups were unclear and deserve additional investigation.« less