Determining optimal clinical target volume margins on the basis of microscopic extracapsular extension of metastatic nodes in patients with non-small-cell lung cancer
Journal Article
·
· International Journal of Radiation Oncology, Biology and Physics
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China)
- Department of Pathology, Shandong Cancer Hospital and Institute, Jinan (China)
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
- Department of Radiation Oncology, Qianfoshan Hospital, Jinan (China)
- Department of Radiology, Second Hospital of Shandong University, Jinan (China)
Purpose: To determine the optimal clinical target volume (CTV) margins around the nodal gross tumor volume (GTV) in non-small-cell lung cancer (NSCLC) patients by assessing microscopic tumor extension beyond regional lymph node capsules. Methods and Materials: The incidence of nodal extracapsular extension (ECE) and relationship with nodal size were reviewed in 243 patients. Histologic sections of dissected regional lymph nodes up to 30 mm in size were examined to measure the extent of microscopic ECE. We determined the distribution of cases according to extent of ECE and the relationships between ECE extent and lymph node size, regional nodal disease extent, histologic type, and degree of differentiation. Results: The nodal ECE was seen in 41.6% of patients (101/243) and 33.4% of lymph nodes (214/640), and the incidence correlated to larger lymph node size positively. The extent of ECE was 0.7 mm in mean (range, 0-12.0 mm) and {<=}3 mm in 95% of the nodes. Positive correlations were found between extent of ECE and larger lymph node size ({>=}20 mm vs. 10-19 mm or <10 mm, p = 0.005), advanced nodal stage (N2 vs. N1, p = 0.046), and moderate or poor (vs. good or unknown) nodal differentiation (p = 0.002). ECE did not differ significantly by histologic type or nodal station. Conclusions: The incidence of ECE related to lymph node size, and ECE extent related to lymph node size, stage, and differentiation. It may be reasonable to recommend 3-mm CTV margins for pathologic lymph nodes <20 mm and more generous margins for lymph nodes {>=}20 mm.
- OSTI ID:
- 20944722
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 67; ISSN IOBPD3; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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