A new nodal delineation protocol for upper third oesophageal cancers in the SCOPE 2 trial
Nicholas, O. Radhakrishna, Ganesh Banner, R. Mukherjee, S. Hawkins, M. Crosby, T Gwynne, S. H.
Nicholas, O.
Radhakrishna, Ganesh
Banner, R.
Mukherjee, S.
Hawkins, M.
Crosby, T
Gwynne, S. H.
Citations
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Abstract
Purpose or Objective
SCOPE 2 is a randomised Phase II/III trial studying
radiotherapy dose escalation and positron emission
tomography (PET) response in patients with oesophageal
cancer treated with definitive chemoradiation. Patients
with upper third oesophageal tumours >15cm ab oral with
supraclavicular fossa (SCF) nodal involvement (N+ by TNM
criteria) are eligible for participation, providing total
contiguous disease length is <10cm. The current
radiotherapy guidance does not specifically cover the
scenario of involved SCF nodes. There are no widely
available delineation protocols for this group of patients.
Therefore, we developed a new protocol to provide
guidance for clinicians and to ensure consistency of nodal
outlining within the trial.
Material and Methods
A literature search was performed to review existing
evidence for elective nodal irradiation (ELNI) and upper
third oesophagus nodal anatomy. Existing nodal outlining
atlases were reviewed, adapted and incorporated into
existing SCOPE 2 radiotherapy guidance to produce the
new protocol.
Results
There is no clinical evidence to recommend ELNI of the SCF
in node negative patients, so this guidance only applies to
patients with positive nodes in the SCF. The lymphatics of
the proximal third oesophagus drain into bilateral deep
cervical nodes that are contained within the SCF (2).
Therefore, we have recommended that patients with
positive SCF nodes receive irradiation of whole ipsilateral
SCF and contralateral SCF. There is no randomisation to
the dose escalation arm of GTVn in SCOPE 2 so CTVscf is
treated to 5000cGy in 25#. Conclusion
This new delineation protocol provides a standardised
approach that can be adopted by the wider radiotherapy
community. Using this protocol within the context of a
randomised trial allows for assessment of loco-regional
control rates, survival data and monitors for unexpected
toxicity. Trial clinical outcome data will inform further
versions of the delineation protocol.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Nicholas O, Radhakrishna G, Banner R, Mukherjee S, Hawkins M, Crosby T, et al. PO-1037: A new nodal delineation protocol for upper third oesophageal cancers in the SCOPE 2 trial. Radiotherapy and Oncology . 2020 Nov;152:S552.