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

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    Authors
    Whitfield, Gillian A
    Jackson, Andrew
    Moore, Christopher J
    Price, Patricia M
    Affiliation
    Academic Department of Radiation Oncology, University of Manchester, Manchester, UK. gillian.whitfield@manchester.ac.uk
    Issue Date
    2008-12
    
    Metadata
    Show full item record
    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.
    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
    URI
    http://hdl.handle.net/10541/67978
    DOI
    10.1259/bjr/23903754
    PubMed ID
    18794193
    Type
    Article
    Language
    en
    ISSN
    1748-880X
    ae974a485f413a2113503eed53cd6c53
    10.1259/bjr/23903754
    Scopus Count
    Collections
    All Christie Publications
    Christie Medical Physics and Engineering Research
    Academic Department of Radiation Oncology - ADRO

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