Radical chemoradiotherapy for adenocarcinoma of the distal oesophagus and oesophagogastric junction: what planning margins should we use?

2.50
Hdl Handle:
http://hdl.handle.net/10541/67978
Title:
Radical chemoradiotherapy for adenocarcinoma of the distal oesophagus and oesophagogastric junction: what planning margins should we use?
Authors:
Whitfield, Gillian A; Jackson, Andrew; Moore, Christopher J; Price, Patricia M
Abstract:
Distal oesophageal and Type I-II oesophagogastric junctional adenocarcinomas have a poor prognosis. In radical chemoradiotherapy, consensus is lacking on radiotherapy margins. Here, we review the effect of common imaging modalities on the extent of the gross tumour volume (GTV) and the evidence for margins. To do this, papers were identified from PubMed, and geometric uncertainties were combined using the British Institute of Radiology formula. CT and endoscopic ultrasound were best for GTV delineation, but the role of positron emission tomography is uncertain. Evidence suggests 3 cm proximal and 5 cm distal GTV-CTV (clinical target volume) margins (along the mucosa) for advanced tumours, but is lacking for early tumours and radial margins. Nodal spread, present in most pT2 tumours, is strongly prognostic and is initially to regional nodes (not wholly covered by typical radiotherapy). Calculated CTV-PTV (planning target volume) margins for three-dimensional conformal radiotherapy using literature estimates of tumour motion and set-up errors with bony online set-up correction, ignoring delineation errors, are 2.2 cm superiorly (sup) and inferiorly (inf) and 1.2-1.3 cm radially (1.3 cm sup-inf; 0.8 cm radially if the tumour's mid-position is known). As these margins may risk excessive toxicity, we propose treating microscopic disease for potentially curable tumours (cT2N0, some cT3N0), but gross disease only for advanced tumours. Recommended GTV-CTV margins are a maximum of 3 cm proximally and 5 cm distally up to cT2N0; 3 cm proximally and 5 cm distally for cT3N0 if anticipated toxicity allows; and 0 cm for cT4 and most node-positive tumours. The CTV-PTV margins above must be added to this for all stages. Methods of including elective nodal areas close to the GTV should be researched, e.g. nodal maps and intensity-modulated radiotherapy.
Affiliation:
Academic Department of Radiation Oncology, University of Manchester, Manchester, UK. gillian.whitfield@manchester.ac.uk
Citation:
Radical chemoradiotherapy for adenocarcinoma of the distal oesophagus and oesophagogastric junction: what planning margins should we use? 2008, 81 (972):921-34 Br J Radiol
Journal:
The British Journal of Radiology
Issue Date:
Dec-2008
URI:
http://hdl.handle.net/10541/67978
DOI:
10.1259/bjr/23903754
PubMed ID:
18794193
Type:
Article
Language:
en
ISSN:
1748-880X
Appears in Collections:
All Christie Publications ; Christie Medical Physics and Engineering Research; Academic Department of Radiation Oncology - ADRO

Full metadata record

DC FieldValue Language
dc.contributor.authorWhitfield, Gillian A-
dc.contributor.authorJackson, Andrew-
dc.contributor.authorMoore, Christopher J-
dc.contributor.authorPrice, Patricia M-
dc.date.accessioned2009-05-12T16:51:47Z-
dc.date.available2009-05-12T16:51:47Z-
dc.date.issued2008-12-
dc.identifier.citationRadical chemoradiotherapy for adenocarcinoma of the distal oesophagus and oesophagogastric junction: what planning margins should we use? 2008, 81 (972):921-34 Br J Radiolen
dc.identifier.issn1748-880X-
dc.identifier.pmid18794193-
dc.identifier.doi10.1259/bjr/23903754-
dc.identifier.urihttp://hdl.handle.net/10541/67978-
dc.description.abstractDistal oesophageal and Type I-II oesophagogastric junctional adenocarcinomas have a poor prognosis. In radical chemoradiotherapy, consensus is lacking on radiotherapy margins. Here, we review the effect of common imaging modalities on the extent of the gross tumour volume (GTV) and the evidence for margins. To do this, papers were identified from PubMed, and geometric uncertainties were combined using the British Institute of Radiology formula. CT and endoscopic ultrasound were best for GTV delineation, but the role of positron emission tomography is uncertain. Evidence suggests 3 cm proximal and 5 cm distal GTV-CTV (clinical target volume) margins (along the mucosa) for advanced tumours, but is lacking for early tumours and radial margins. Nodal spread, present in most pT2 tumours, is strongly prognostic and is initially to regional nodes (not wholly covered by typical radiotherapy). Calculated CTV-PTV (planning target volume) margins for three-dimensional conformal radiotherapy using literature estimates of tumour motion and set-up errors with bony online set-up correction, ignoring delineation errors, are 2.2 cm superiorly (sup) and inferiorly (inf) and 1.2-1.3 cm radially (1.3 cm sup-inf; 0.8 cm radially if the tumour's mid-position is known). As these margins may risk excessive toxicity, we propose treating microscopic disease for potentially curable tumours (cT2N0, some cT3N0), but gross disease only for advanced tumours. Recommended GTV-CTV margins are a maximum of 3 cm proximally and 5 cm distally up to cT2N0; 3 cm proximally and 5 cm distally for cT3N0 if anticipated toxicity allows; and 0 cm for cT4 and most node-positive tumours. The CTV-PTV margins above must be added to this for all stages. Methods of including elective nodal areas close to the GTV should be researched, e.g. nodal maps and intensity-modulated radiotherapy.en
dc.language.isoenen
dc.subjectOesophageal Canceren
dc.subjectCancer Stagingen
dc.subject.meshAdenocarcinoma-
dc.subject.meshCombined Modality Therapy-
dc.subject.meshEsophageal Neoplasms-
dc.subject.meshEsophagogastric Junction-
dc.subject.meshHumans-
dc.subject.meshLymphatic Metastasis-
dc.subject.meshNeoplasm Staging-
dc.subject.meshPositron-Emission Tomography-
dc.subject.meshRadiotherapy Planning, Computer-Assisted-
dc.subject.meshRadiotherapy, Conformal-
dc.subject.meshTomography, X-Ray Computed-
dc.titleRadical chemoradiotherapy for adenocarcinoma of the distal oesophagus and oesophagogastric junction: what planning margins should we use?en
dc.typeArticleen
dc.contributor.departmentAcademic Department of Radiation Oncology, University of Manchester, Manchester, UK. gillian.whitfield@manchester.ac.uken
dc.identifier.journalThe British Journal of Radiologyen

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