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Residual Tumor After Neoadjuvant Chemoradiation Outside the Radiation Therapy Target Volume

Authors :
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)
Targeted Gynaecologic Oncology (TARGON)
Source :
International Journal of Radiation Oncology Biology Physics, 88(4), 845-852. ELSEVIER SCIENCE INC
Publication Year :
2014
Publisher :
ELSEVIER SCIENCE INC, 2014.

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.

Details

Language :
English
ISSN :
1879355X and 03603016
Volume :
88
Issue :
4
Database :
OpenAIRE
Journal :
International Journal of Radiation Oncology Biology Physics
Accession number :
edsair.doi.dedup.....9f3061a1bd7d4d3ffa5ff05741b125fd