PET-CT offers accurate assessment of tumour length in oesophageal malignancy

Rollins, Katie E.; Lucas, Emma S.; Tewari, Nilanjana; James, Eleanor; Hughes, Simon; Catton, J.A.

doi:10.1016/j.ejrad.2014.10.014

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…The first one is, that identification of the macroscopic primary tumor with CT is often difficult and reveals a high inter-observer variability [ 15 ]. However, in recent years modern imaging techniques like PET/CT or magnetic resonance imaging have demonstrated their potential to improve tumor staging and target delineation for SCC [ 16 – 19 ] and therefore longitudinal safety margins have already been reduced in the past [ 6 , 8 , 10 ]. This is especially important because in contrast to other tumor entities no elective nodal irradiation (ENI) is performed for SCC [ 20 , 21 ] and therefore, the extension of the primary tumor is directly associated with the extension of the CTV and the PTV.…”

Section: Discussionmentioning

confidence: 99%

DVH- and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer

et al. 2017

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PurposeTo cover the microscopic tumor spread in squamous cell carcinoma of the esophagus (SCC), longitudinal margins of 3–4 cm are used for radiotherapy (RT) protocols. However, smaller margins of 2–3 cm might be reasonable when advanced diagnostic imaging is integrated into target volume delineation. Purpose of this study was to compare the dose distribution and deposition to the organs at risk (OAR) for different longitudinal margins using a DVH- and NTCP-based approach.MethodsTen patients with SCC of the middle or lower third were retrospectively selected. Three planning target volumes (PTV) with longitudinal margins of 4 cm, 3 cm and 2 cm and an axial margin of 1.5 cm to the gross target volume (GTV) were defined for each patient. For each PTV two treatment plans with total doses of 41.4 Gy (neoadjuvant treatment) and 50.4 Gy (definite treatment) were calculated. Dose to the lungs, heart, myelon and liver were then evaluated and compared between different PTVs.ResultsWhen using a longitudinal margin of 3 cm instead of 4 cm, all dose parameters (Dmin, Dmean, Dmedian and V5-V35), except Dmax could be significantly reduced for the lungs. Regarding the heart, a significant reduction was seen for Dmean and V5, but not for Dmin, Dmax, Dmedian and V10-V35. When comparing a longitudinal margin of 4 cm to a longitudinal margin of 2 cm, a significant difference was calculated for Dmin, Dmean, Dmedian and V5-V35 of the lungs and for Dmax, Dmean and V5-V35 of the heart. Nevertheless, no difference was seen for median heart dose. An additional dose reduction for V10 of the heart was achieved for definite treatment plans when using a longitudinal margin of 3 cm. The NTCP-based risk of pneumonitis was significantly reduced by a margin reduction to 2 cm for neoadjuvant and definite treatment plans.ConclusionReduction of longitudinal margins from 4 cm to 3 cm can significantly reduce the dose to lungs and Dmean of the heart. Despite clinical benefit and oncologic outcome remain unclear, reduction of the longitudinal margins might provide the opportunity to reduce side effects of chemoradiation (CRT) for SCC in upcoming studies.

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Section: Discussionmentioning

confidence: 99%

DVH- and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer

et al. 2017

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“…Precise EC tumor measurements are important for accurate radiation targeting and treatment. PET has been found to be accurate for evaluation of tumor length in esophageal cancers[ 84 - 86 ]. In a retrospective study of 53 patients by Rollins et al[ 84 ] PET and EUS were compared to surgical pathology for measurement of tumor length.…”

Section: Radiation Therapy Field Delineationmentioning

confidence: 99%

“…PET has been found to be accurate for evaluation of tumor length in esophageal cancers[ 84 - 86 ]. In a retrospective study of 53 patients by Rollins et al[ 84 ] PET and EUS were compared to surgical pathology for measurement of tumor length. Both PET and EUS correlated significantly with resection specimen tumor length; PET (Pearson R = 0.5977, 95%CI: 0.390-0.747, P < 0.0001) vs EUS (Pearson R = 0.5365, 95%CI: 0.311-0.705, P < 0.0001).…”

Section: Radiation Therapy Field Delineationmentioning

confidence: 99%

Is endoscopic ultrasound examination necessary in the management of esophageal cancer?

DaVee

Ajani

Lee

2017

WJG

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Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.

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“…Longitudinal tumor growth along the esophageal submucosa has been implicated as a predisposing factor towards lymph node metastasis and the development of micrometastases[20], thereby reducing survival. Interestingly, Rollins et al [25] identified that tumor length on PET-CT and histopathology were significantly correlated, with a Pearson r = 0.5977 [25]. Given this correlation, we would expect to observe an association between PET-CT tumor length and OS in our study.…”

Section: -Histopathological Variablesmentioning

confidence: 49%

Pre- and postoperative prognostic factors for resectable esophageal adenocarcinoma

et al. 2020

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PET-CT offers accurate assessment of tumour length in oesophageal malignancy

Cited by 5 publications

References 15 publications

DVH- and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer

DVH- and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer

Is endoscopic ultrasound examination necessary in the management of esophageal cancer?

Pre- and postoperative prognostic factors for resectable esophageal adenocarcinoma

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