1. Residual Tumor After Neoadjuvant Chemoradiation Outside the Radiation Therapy Target Volume
- Author
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Geke A. P. Hospers, Phillip Kluin, Justin K. Smit, Johannes A. Langendijk, Veronique E.M. Mul, Go M. van Dam, John T. M. Plukker, Jannet C. Beukema, Arend Karrenbeld, Christina T. Muijs, Microbes in Health and Disease (MHD), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Stem Cell Aging Leukemia and Lymphoma (SALL), and Targeted Gynaecologic Oncology (TARGON)
- Subjects
Oncology ,Male ,Cancer Research ,Neoplasm, Residual ,Esophageal Neoplasms ,medicine.medical_treatment ,Radiotherapy Planning ,Carboplatin ,Computer-Assisted ,Antineoplastic Combined Chemotherapy Protocols ,80 and over ,Prospective Studies ,Prospective cohort study ,Adjuvant ,Aged, 80 and over ,Radiation ,Hazard ratio ,Esophageal cancer ,Middle Aged ,Prognosis ,Tumor Burden ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,Residual ,Carcinoma, Squamous Cell ,Adenocarcinoma ,Regression Analysis ,Female ,Radiology ,Anatomic Landmarks ,Adult ,medicine.medical_specialty ,Paclitaxel ,Disease-Free Survival ,Internal medicine ,medicine ,Carcinoma ,Chemotherapy ,Humans ,Radiology, Nuclear Medicine and imaging ,Esophagus ,Aged ,Neoplasm Staging ,business.industry ,Proportional hazards model ,Radiotherapy Planning, Computer-Assisted ,medicine.disease ,Radiation therapy ,Squamous Cell ,Neoplasm ,business - Abstract
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 (PConclusions: 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. (C) 2014 Elsevier Inc.
- Published
- 2014