Residual Tumor After Neoadjuvant Chemoradiation Outside the Radiation Therapy Target Volume: A New Prognostic Factor for Survival in Esophageal Cancer

Journal Article · Sat Mar 15 04:00:00 EDT 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2013.11.009· OSTI ID:22416493

Muijs, Christina ^[1]; Smit, Justin ^[2]; Karrenbeld, Arend ^[3]; Beukema, Jannet; Mul, Veronique ^[1]; Dam, Go van ^[2]; Hospers, Geke ^[4]; Kluin, Phillip ^[3]; Langendijk, Johannes ^[1]; Plukker, John ^[2]

---

1. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)
2. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)
3. Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)
4. Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)

Purpose/Objective(s): The aim of this study was to analyze the accuracy of gross tumor volume (GTV) delineation and clinical target volume (CTV) margins for neoadjuvant chemoradiation therapy (neo-CRT) in esophageal carcinoma at pathologic examination and to determine the impact on survival. Methods and Materials: The study population consisted of 63 esophageal cancer patients treated with neo-CRT. GTV and CTV borders were demarcated in situ during surgery on the esophagus, using anatomical reference points to provide accurate information regarding tumor location at pathologic evaluation. To identify prognostic factors for disease-free survival (DFS) and overall survival (OS), a Cox regression analysis was performed. Results: After resection, macroscopic residual tumor was found outside the GTV in 7 patients (11%). Microscopic residual tumor was located outside the CTV in 9 patients (14%). The median follow-up was 15.6 months. With multivariate analysis, only microscopic tumor outside the CTV (hazard ratio [HR], 4.96; 95% confidence interval [CI], 1.03-15.36), and perineural growth (HR, 5.77; 95% CI, 1.27-26.13) were identified as independent prognostic factors for OS. The 1-year OS was 20% for patients with tumor outside the CTV and 86% for those without (P<.01). For DFS, microscopic tumor outside the CTV (HR, 5.92; 95% CI, 1.89-18.54) and ypN+ (HR, 3.36; 95% CI, 1.33-8.48) were identified as independent adverse prognostic factors. The 1-year DFS was 23% versus 77% for patients with or without tumor outside the CTV (P<.01). Conclusions: Microscopic tumor outside the CTV is associated with markedly worse OS after neo-CRT. This may either stress the importance of accurate tumor delineation or reflect aggressive tumor behavior requiring new adjuvant treatment modalities.

• OSTI ID: 22416493
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 88; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ACCURACY
CARCINOMAS
CHEMOTHERAPY
COMBINED THERAPY
ESOPHAGUS
HAZARDS
MULTIVARIATE ANALYSIS
PATIENTS
RADIOTHERAPY
REGRESSION ANALYSIS
SURGERY