Selectively sparing the submandibular gland when level Ib lymph nodes are included in the radiation target volume: An initial safety analysis of a novel planning objective

AimsRadiotherapy with concurrent 5-fluorouracil/mitomycin-C based chemotherapy has been established as definitive standard therapy approach for anal cancer. Intensity Modulated Radiotherapy (IMRT) leads to a precise treatment of the tumor, allowing dose escalation on Gross Tumor Volume (GTV), with a surrounding healthy tissues sparing. Our study assessed the impact of 18-Fluorodeoxyglucose positron emission tomography (18FDG-PET/CT) on the radiotherapy contouring process and its contribution to lymphatic spread detection, resulting to a personalization of Clinical Target Volume (CTV) and dose prescription.MethodsThirty-seven patients, with histologically proven squamous cell carcinoma of the anal canal (SCCAC) were analyzed. All patients were evaluated with history and physical examination, trans-anal endoscopic ultrasound, pelvis magnetic resonance imaging (MRI), computed tomography (CT) scans of the chest, abdomen and pelvis and planning 18FDG-PET/CT. The GTV and CTV were drawn on CT, MRI and 18FDG-PET/CT fused images.ResultsThirty-four (91%) out of 37 patients presented lymph nodes involvement, in one or more areas, detected on 18FDG-PET/CT and/or MRI. The 18FDG-PET/CT showed positive lymph nodes not detected on MRI imaging (PET+, MRI−) in 14/37 patients (38%). In 14 cases, 18FDG-PET/CT allowed to a dose escalation in the involved nodes. The 18FDG-PET/CT fused images led to change the stage in 5/37(14%) cases: four cases from N0 to N1 (inguinal lymph nodes) and in one case from M0 to M1 (common iliac lymph nodes).ConclusionsThe 18FDG-PET/CT has a potentially relevant impact in staging and target volume delineation/definition in patients affected by anal cancer. In our experience, clinical stage variation occurred in 14% of cases. More investigations are needed to define the role of 18FDG-PET/CT in the target volume delineation of anal cancer.

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Comment on “Cranial Location of Level II Lymph Nodes in Laryngeal Cancer: Implications for Elective Nodal Target Volume Delineation”: In Regard to Braam et al. (Int J Radiat Oncol Biol Phys 2007;67:462–468)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2007.03.034 ◽

2007 ◽

Vol 68 (5) ◽

pp. 1582-1583 ◽

Cited By ~ 2

Author(s):

Gokhan Ozyigit ◽

Ugur Selek ◽

Mustafa Cengiz ◽

Ferah Yildiz

Keyword(s):

Lymph Nodes ◽

Laryngeal Cancer ◽

Radiat Oncol Biol Phys ◽

Target Volume ◽

Target Volume Delineation ◽

Volume Delineation ◽

Level Ii

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The Prognosis and Feasibility of Extensive Clinical Target Volume in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma: A Phase II Clinical Trial

Frontiers in Oncology ◽

10.3389/fonc.2021.669575 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xiaofei Zhang ◽

Dashan Ai ◽

Juanqi Wang ◽

Yun Chen ◽

Qi Liu ◽

...

Keyword(s):

Clinical Trial ◽

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Squamous Cell ◽

Postoperative Radiotherapy ◽

Locally Advanced ◽

Target Volume ◽

Local Control Rate

BackgroundThis trial aims to explore the feasibility and safety of postoperative radiotherapy covering all regional lymph node areas for locally advanced thoracic esophageal squamous cell carcinoma patients treated with intensity-modulated radiation therapy (IMRT).MethodsThis was a single-center single-arm, phase II clinical trial initiated in 2014. Patients who were treated with radical transthoracic resection and had negative margins within 3 months and histologically confirmed esophageal squamous cell carcinoma (pT3-4 or N+, M0 determined by the 7th edition of the AJCC guidelines) were recruited in this trial. Postoperative radiotherapy was performed with a total dose of 40 Gy in 20 fractions using IMRT. Clinical target volumes (CTVs) included the tumor bed, anastomosis, bilateral supraclavicular region, mediastinal lymph nodes, left gastric lymph nodes and celiac trunk lymph nodes. The primary endpoint was the 2-year local control rate, and the secondary endpoints were overall survival (OS) and adverse events (AEs).ResultsA total of 70 eligible patients were recruited from 2014 to 2016. The 2-year local control rate, as the primary endpoint, was 67.3%. In addition, the median OS was 57.0 months, with 1-year and 3-year OS rates of 92.8% and 60.9%, respectively. Among the patients, 28/40 (40%) developed locoregional recurrence, with 25.7% involving hematogenous recurrences. All reported AEs occurred during the course of IMRT or within 6 months thereafter. None of them suffered grade 4 hematological or nonhematological AEs. Nearly all patients completed the entire course of postoperative radiotherapy, with a completion rate of 97.1%.ConclusionFor an extensive target volume, 40 Gy is feasible and shows acceptable toxicity in patients with locally advanced thoracic esophageal squamous cell carcinoma, although the local recurrence rate is relatively high. Our findings provide a basis for further exploration of high-dose radiation with extensive CTV combined with chemotherapy.Clinical Trial Registration[http://www.clinicaltrials.gov/ct2/results?cond=&term=NCT02384811&cntry=&state=&city=&dist=], identifier [NCT02384811].

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EP-1165 Failure Patterns of Cervical Lymph Nodes in Metastases of Unknown Primary according to Target Volume

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)31585-3 ◽

2019 ◽

Vol 133 ◽

pp. S645

Author(s):

D.Y. Kim ◽

D.S. Heo ◽

B. Keam ◽

S. Ahn ◽

J. Kim ◽

...

Keyword(s):

Lymph Nodes ◽

Target Volume ◽

Unknown Primary ◽

Cervical Lymph Nodes ◽

Failure Patterns

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RA04.05: PREVALENCE OF LYMPH-NODE METASTASIS IN T1B ESOPHAGEAL SQUAMOUS CELL CANCER: IMPLICATIONS FOR ADDITIONAL RADIOTHERAPY DESIGN FOLLOWING ENDOSCOPIC SUBMUCOSAL DISSECTION

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra04.05 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 26-26

Author(s):

Jun Liu ◽

Xiaolong Fu ◽

Hongxuan Li ◽

Yan Cheng ◽

Zhigang Li

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Endoscopic Submucosal Dissection ◽

Squamous Cell ◽

Clinical Target Volume ◽

Target Volume ◽

Lymph Nodes Metastasis ◽

Node Metastasis ◽

Submucosal Dissection

Abstract Background Endoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for early esophageal cancer. But how to prevent lymph node metastasis is essential in these patients. This study aimed to analyze prevalence of lymph nodes metastasis for T1b thoracic esophageal squamous cell carcinoma(TESCC) patients treated in Shanghai Chest Hospital(SCH) and to propose a clinical target volume (CTV) for additional radiotherapy Clinical Target Volume design following endoscopic submucosal dissection(ESD) in these patients. Methods From 2012 to 2017, consecutive patients with T1b TESCC patients who underwent complete resection in SCH were identified. The prevalence of lymph-node metastasis were assessed and evaluated whether these metastasis areas would be encompassed by our proposed CTV. We proposed lymph-node stations (JEOG) 101, 104, 105, 106, 107 for upper TESCC, lymph-node stations 106, 107, 108, 1, 2, 3, 7, 8, 9, 10 for middle TESCC, and lymph-node stations110, 112, 1, 2, 3, 7, 8, 9, 10 for lower TESCC. Results There were 240 patients (80.4% male) who met the inclusion criteria, with a mean age of 62 ± 7 years. Of the total, 27.1%(65/240) patients presented with lymph nodes metastasis. Single lymph-node and single station lymph-node metastasis among positive nodes patients were 63.1%(41/65) and 70.8%(46/65), respectively.Tumor length exceeding 20mm and poor tumor differentiation but not age, gender, tumor position and tumor thrombus were independently associated with the risk of nodal disease. Among positive nodes patients, 89.2% (58/65) lymph-node metastasis for T1b TESCC patients could be covered by proposed CTV. Conclusion Prevalence of lymph node metastasis is high in patients with T1b TESCC. It seemed additional radiotherapy after ESD for those patients with high risk factors is needed to prevent lymph node metastasis. Majority positive nodes area could be covered by our proposed CTV. However, the value of radiotherapy and the proposed CTV should be investigated in further prospective studies. Disclosure All authors have declared no conflicts of interest.

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