782 PATTERNS OF FAILURE AND ADEQUACY OF CLINICAL TARGET VOLUME (CTV) MARGINS IN PATIENTS TREATED WITH DEFINITIVE CHEMO-RADIATION IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Tahseena Tahmeed ◽  
Anil Tibdewal ◽  
Sarbani Ghosh-Laskar ◽  
Naveen Mummudi ◽  
Vanita Noronha ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Target Volume ◽  
Target Volume ◽  
Patterns Of Failure ◽  
Local Site ◽  
Pet Ct ◽  
Upper Gi Endoscopy ◽  
Upper Third ◽  
Anterior Posterior

Abstract   Esophageal cancer is a locally aggressive malignancy with dismal overall survival (OS) rates. Approximately 50–60% of patients fail loco-regionally after definitive chemoradiation (CTRT). There is a lack of consensus regarding clinical target volume (CTV) margins. Improved diagnostic investigations and patterns of failure (POF) data, suggested scope of reduced CTV margins. In this retrospective study, we evaluated the POF (defined as first site of failure) and the adequacy of CTV margins. Methods All patients treated with CTRT between Jan 2013 to Dec 2017 were included. CTV margin was given as 3–5 cm cranio-caudal and 1–1.5 cm radial from gross tumor volume (GTV). Patients were treated either with combined technique (anterior–posterior followed by conformal) or with volumetric arc radiotherapy to a dose of 60-63Gy in 30–35 fractions. PET-CT/CT thorax and upper GI-endoscopy were performed at regular intervals. Loco-regional failure (LRF) was defined as recurrence at local site or regional nodes respectively and classified as infield, marginal and out-field. CT was co-registered with planning CT to document these failures. Results 158 patients were eligible. Twenty-one patients were excluded as they either progressed or did not attend the first follow-up. Median age was 57 years, >90% had squamous histology, and most common subsite was upper third. Median follow-up was 45.8 months, 53 patients (41.7%) had progression. Local recurrence (LR) was seen in 37 (69.8%), followed by regional in 25 (47.1%) and distant in 21 patients (39.6%). All LR were within the GTV. Of regional failures, 50% were within GTV and 50% were outside the radiotherapy portals. This suggest that 3 cm cranio-caudal CTV margin was adequate. Conclusion Our study demonstrated that loco-regional recurrence was the most common pattern of failure after definitive CTRT. As majority of loco-regional failures were within the GTV, hence, 3 cm cranio-caudal CTV margins appear to be adequate enough for control of microscopic disease. Further prospective studies are needed to validate the use of 3 cm CTV margins in definitive CTRT for esophageal cancer.

scholarly journals 18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy

2021 ◽  
Vol 20 ◽  
pp. 153303382110246
Author(s):  
Seokmo Lee ◽  
Yunseon Choi ◽  
Geumju Park ◽  
Sunmi Jo ◽  
Sun Seong Lee ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Concurrent Chemoradiotherapy ◽  
Curative Intent ◽  
Squamous Cell Esophageal Cancer ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume

2005 ◽  
Vol 32 (12) ◽  
pp. 1392-1399 ◽  
Author(s):  
Ernesto Brianzoni ◽  
Gloria Rossi ◽  
Sergio Ancidei ◽  
Alfonso Berbellini ◽  
Francesca Capoccetti ◽  
...  
Keyword(s):  
Clinical Target Volume ◽  
Tumour Volume ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Gross Tumour Volume ◽  
Ct Scanner ◽  
Pet Ct ◽  
Definition Of

Clinical value of FDG PET/CT in predicting local failure in patients with esophageal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15197-e15197
Author(s):  
Bingjie Fan ◽  
Man Hu ◽  
Li Kong ◽  
Xiaoli Zhang ◽  
Zheng Fu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Local Recurrence ◽  
Fdg Pet ◽  
Residual Tumor ◽  
Local Failure ◽  
Fdg Uptake ◽  
Failure Patterns ◽  
Pet Ct ◽  
Fdg Pet Ct

e15197 Background: Local failure, including local residual tumor and local recurrence, is the most common failure patterns for patients with esophageal cancer (EC) treated with radiotherapy. The purpose of this study was to evaluate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for predicting local failure in patients with EC. Methods: Twenty-two patients with biopsy-proven EC treated definitively with RT with or without chemotherapy were enrolled from June 2010 to August 2012. Dose of 60.4 - 70.2 Gy with 1.8 - 2.0Gy /fraction were delivered with three-dimensional conformal radiation therapy (CRT). All patients underwent FDG PET/CT scan prior to therapy. The patients were followed up every 3 months after treatment completion. Patients who developed local failure were confirmed with histological evidence or follow-up. Results: The follow up time was in the range of 5-30 months. Of 22 patients, 3 patients had local residual tumor, 2 patients experienced local recurrence. The mean SUVmax for patients with local failure was higher than that for patients without local failure (15.688±3.115 vs. 14.137± 4.397, p = 0.54). The local failure regions were mostly the regions with higher metabolic activity before radiotherapy. Conclusions: Patients with higher FDG-uptake may have higher risk to experienced local failure. The local failure regions were localized mostly in the higher FDG uptake regions of pre-therapeutically FGD PET/CT scans of the patients with EC.

Patterns of failure following tri-modality therapy for locally advanced esophageal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 203-203
Author(s):  
Talha Shaikh ◽  
Mark A. Zaki ◽  
Michael M. Dominello ◽  
Elizabeth Handorf ◽  
Andre A. Konski ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Metastatic Disease ◽  
Locally Advanced ◽  
Post Treatment ◽  
Advanced Esophageal Cancer ◽  
Patterns Of Failure ◽  
Cancer Data ◽  
Locally Advanced Esophageal Cancer

203 Background: Although tri-modality therapy is an acceptable standard of care in patients with locally advanced esophageal cancer, data regarding patterns of failure is lacking. We report bi-institutional patterns of failure experience treating patients using tri-modality therapy. Methods: Following IRB approval, we retrospectively reviewed all pts who underwent chemoradiation followed by esophagectomy at two NCI-designated cancer centers from 2000-2013. Patient and treatment factors were analyzed for failure patterns. First failure sites were categorized as local, regional nodal, or distant. Statistical analysis was performed using Fisher’s exact test and non-parametric Wilcoxon rank-sum test. Results: A total of 132 patients met the inclusion criteria with a median age of 62 (range 36-80) and median follow-up of 28 months (range 4-128). The majority of patients had T3 (82%), N1 (64%), or M0/M1a (92%) disease. At the time of last follow-up there were a total of 6 (4.5%) local, 13 (10%) regional nodal, and 32 (23.5%) distant failures. Local failure was correlated with fewer lymph nodes assessed (p=0.01) and close or positive margins (p<0.01). Regional nodal failure was correlated with fewer lymph nodes assessed (p<0.01) and smaller pre-treatment tumor size (p=0.04). Distant recurrence was correlated with post-treatment nodal stage (p<0.01), peri-neural invasion (p=0.03), negative margins (p=0.02), ulceration (p=0.02), incomplete response (p<0.01), post-treatment PET SUV (p=0.05), 3D-CRT (0.053), metastatic disease at diagnosis (p<0.01) and post-treatment metastatic disease (p<0.01). No other patient, tumor, or treatment factor was correlated with treatment failure. Conclusions: Per our bi-institutional experience, patient, tumor, and treatment factors may predict for failure in patients undergoing tri-modality therapy for locally advanced esophageal cancer. Further data is needed to identify patterns of failure in these patients.

scholarly journals [F18] FDG-PET/CT for manual or semiautomated GTV delineation of the primary tumor for radiation therapy planning in patients with esophageal cancer: is it useful?

2020 ◽  
Author(s):  
Franziska Walter ◽  
Constanze Jell ◽  
Barbara Zollner ◽  
Claudia Andrae ◽  
Sabine Gerum ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Primary Tumor ◽  
Fdg Pet ◽  
Interobserver Variability ◽  
Target Volume ◽  
Standardized Uptake Values ◽  
Positron Emission ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct

Abstract Background Target volume definition of the primary tumor in esophageal cancer is usually based on computed tomography (CT) supported by endoscopy and/or endoscopic ultrasound and can be difficult given the low soft-tissue contrast of CT resulting in large interobserver variability. We evaluated the value of a dedicated planning [F18] FDG-Positron emission tomography/computer tomography (PET/CT) for harmonization of gross tumor volume (GTV) delineation and the feasibility of semiautomated structures for planning purposes in a large cohort. Methods Patients receiving a dedicated planning [F18] FDG-PET/CT (06/2011–03/2016) were included. GTV was delineated on CT and on PET/CT (GTVCT and GTVPET/CT, respectively) by three independent radiation oncologists. Interobserver variability was evaluated by comparison of mean GTV and mean tumor lengths, and via Sørensen–Dice coefficients (DSC) for spatial overlap. Semiautomated volumes were constructed based on PET/CT using fixed standardized uptake values (SUV) thresholds (SUV30, 35, and 40) or background- and metabolically corrected PERCIST-TLG and Schaefer algorithms, and compared to manually delineated volumes. Results 45 cases were evaluated. Mean GTVCT and GTVPET/CT were 59.2/58.0 ml, 65.4/64.1 ml, and 60.4/59.2 ml for observers A–C. No significant difference between CT- and PET/CT-based delineation was found comparing the mean volumes or lengths. Mean Dice coefficients on CT and PET/CT were 0.79/0.77, 0.81/0.78, and 0.8/0.78 for observer pairs AB, AC, and BC, respectively, with no significant differences. Mean GTV volumes delineated semiautomatically with SUV30/SUV35/SUV40/Schaefer’s and PERCIST-TLG threshold were 69.1/23.9/18.8/18.6 and 70.9 ml. The best concordance of a semiautomatically delineated structure with the manually delineated GTVCT/GTVPET/CT was observed for PERCIST-TLG. Conclusion We were not able to show that the integration of PET/CT for GTV delineation of the primary tumor resulted in reduced interobserver variability. The PERCIST-TLG algorithm seemed most promising compared to other thresholds for further evaluation of semiautomated delineation of esophageal cancer.

scholarly journals Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume

2005 ◽  
Vol 32 (12) ◽  
pp. 1491-1491
Author(s):  
Ernesto Brianzoni ◽  
Gloria Rossi ◽  
Sergio Ancidei ◽  
Alfonso Berbellini ◽  
Francesca Capoccetti ◽  
...  
Keyword(s):  
Clinical Target Volume ◽  
Tumour Volume ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Gross Tumour Volume ◽  
Ct Scanner ◽  
Pet Ct ◽  
Definition Of
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