CT-based definition of thoracic lymph node stations: An atlas from the University of Michigan

Chapet, O.; Kong, Feng Ming; Quint, Leslie E.; Chang, Andrew C.; Haken, Randall K. Ten; Eisbruch, Avraham; Hayman, James A.

doi:10.1016/j.ijrobp.2004.12.060

Cited by 131 publications

(100 citation statements)

References 12 publications

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“…The fields in the protocol for extended ENI had to be stopped at the sternal notch. This was also recommended by Chapet et al [15] as the upper limit for LNS of the superior mediastinum. For this reason, it is not surprising, that the full prescribed elective doses were not applied at the border of the field.…”

Section: Discussionmentioning

confidence: 90%

“…It was basically related to the limitation of the method of the delineation of the LNS. Chapet et al [15] did not recommend a separate delineation of LNS 1 and 2 in the superior mediastinum, because both stations cover only a very short vertical distance and division by a left innominate vein is not always easy to be found. The fields in the protocol for extended ENI had to be stopped at the sternal notch.…”

Section: Discussionmentioning

confidence: 99%

“…The recommendations of Chapet et al [15] for a delineation of the LNS on the cross-sectional imaging were proposed as useful tool for reporting on doses of incidental irradiation. The problem is that those recommendations have not been validated for clinical use.…”

Section: Discussionmentioning

confidence: 99%

“…The LNS were delineated strictly according to the recommendations of the Atlas from the University of Michigan [15], except superior borders for 3A and 3P, which were placed at the level of superior limits of the aortic arch (as for 4R). This lower placement of the limits for these groups was set, because the dose volume histograms (DVHs) for LNS 1/2R and 1/2L had already given an estimation of the dose in the superior mediastinum.…”

Section: Evaluation Of Doses Received By Particular Lnsmentioning

confidence: 99%

“…A recent publication by Chapet et al [15], providing recommendations on the definition of the borders of mediastinal and hilar LNS in the CT has produced an opportunity for detailed reporting on the intended and non-intended doses received by particular LNS. Information about an amount of incidental irradiation in different clinical and technical settings may help clinicians construct the ENI volumes which would be smaller than ones traditionally utilized in view of the improvement of the therapeutic ratio.…”

mentioning

confidence: 99%

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Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

et al. 2008

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To estimate the doses of incidental irradiation in particular lymph node stations (LNS) in different extents of elective nodal irradiation (ENI) in 3D-conformal radiotherapy (3D-CRT) for non-small cell lung cancer (NSCLC). Methods. Doses of radiotherapy were estimated for particular LNS delineated according to the recommendations of the University of Michigan in 220 patients treated using 3D-CRT with different (extended, limited and omitted) extents of ENI. Minimum doses and volumes of LNS receiving 40 Gy or more (V 40 ) were compared for omitted vs. limited' extended ENI and limited vs. extended ENI. Results. For omission of the ENI the minimum doses and V 40 for particular LNS were significantly lower than for patients treated with ENI. For the limited ENI group, the minimum doses for LNS 5, 6 lower parts of 3A and 3P (not included in the elective area) did not differ significantly from doses given to respective LNS for extended ENI group. When the V 40 values for extended and limited ENI were compared, no significant differences were seen for any LNS, except for group 1/2R, 1/2L. Conclusions. Incidental irradiation of untreated LNS seems play a part in case of limited ENI, but not in cases without ENI. For subclinical disease the delineation of uninvolved LNS 5, 6, and lower parts of 3A, 3P may be not necessary, because these stations receive the substantial part of irradiation incidentally, if LNS 4R, 4L, 7, and ipsilateral hilum are included in the elective area while this is not case for stations 1 and 2.There is increasing evidence, derived especially from dose escalation studies that the omission of elective nodal irradiation (ENI) in radiotherapy of non-small cell lung cancer (NSCLC) results in a low incidence of isolated nodal failures (INF) [1Á 10]. The prerequisite for reporting on the incidence of INF after radiotherapy with the omission of ENI is an evaluation of incidental irradiation received by omitted nodal stations. In some cases the incidental irradiation may be enough to eradicate subclinical nodal disease [11]. Thus, although regional nodes are not purposefully included into the clinical target volume, they might actually receive elective irradiation. In the previous analysis of our data [12], the two-year cumulative incidence of INF for 185 patients treated with 3-dimensional conformal radiotherapy (3D-CRT) and different (limited or extended) extents of ENI was 12%.INF was defined as a regional failure occurring outside gross tumor volume (GTV) without previous or synchronous local progression regardless of the distant metastases status. There was no difference in the cumulative incidence of INF for patients treated with extended and limited mediastinal ENI. One of the possible explanations of this finding is that the incidental irradiation may play a role in the limited ENI.The low incidence of INF reported in the dose escalation studies may be related to the unintended dose received by lymph node stations (LNS) at risk. Published data on incidental irradiation in radiotherapy for lung c...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Evaluation Of Doses Received By Particular Lnsmentioning

confidence: 99%

mentioning

confidence: 99%

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Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

et al. 2008

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Guidelines for Radiotherapy of Esophageal Carcinoma (2020 Edition)

Gong

2021

Precision Radiation Oncology

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Esophageal carcinoma is a high-incidence malignant tumor in China, ranking sixth and fourth highest in morbidity and mortality, respectively. Radiotherapy plays an important role in the comprehensive treatment of esophageal carcinoma. Standardized diagnosis and treatment based on the suggestions of a multidisciplinary team (MDT) form its foundation. For operable esophageal carcinoma, surgery after neoadjuvant chemoradiotherapy is the standard treatment; contrarily, for inoperable esophageal carcinoma, radical chemoradiotherapy is the only treatment option, and postoperative adjuvant radiotherapy can improve local control and survival rates in selected cases. Owing to the rapid technological development in radiotherapy, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and image guidance technology are widely used in the treatment of esophageal carcinoma. Though drugs for treating cancer have been developed rapidly, we need to explore their optimal combination with radiotherapy, including chemotherapy, targeted or immune, and radiosensitizers.Esophageal carcinoma in China differs greatly from that in European and American countries in terms of etiology, pathological type, highincidence site, etc. Therefore, the European and American guidelines on radiotherapy for esophageal carcinoma cannot be applied in clinical practice in China. This gap was addressed when the 2019 edition of This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Correlation of displacement of mediastinal metastatic lymph nodes with adjacent organs in non‐small cell lung cancer on four‐dimensional computed tomography

Wang

Xing

et al. 2019

Precision Radiation Oncology

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Objective To determine the correlation of displacement of the mediastinal metastatic lymph nodes with adjacent organs in non‐small cell lung cancer using four‐dimensional computed tomography. Methods The displacements of 51 mediastinal metastatic lymph nodes located in the left–right, anterior–posterior, and superior–inferior directions were measured using four‐dimensional computed tomography. Correlation analyses were carried out to determine the association between the displacement of lymph nodes and volumetric change of the lungs and heart. Results A significant correlation of displacement of the left group lymph nodes in left–right and the right group in anterior–posterior directions with volumetric change of the ipsilateral lung was observed. There were significant correlations between displacement of the left group lymph nodes and volumetric change of the heart. Conclusion Displacement of the mediastinal metastatic lymph nodes was relevant to the adjacent organs.

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CT-based definition of thoracic lymph node stations: An atlas from the University of Michigan

Cited by 131 publications

References 12 publications

Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

Incidental irradiation of mediastinal and hilar lymph node stations during 3D-conformal radiotherapy for non-small cell lung cancer

Guidelines for Radiotherapy of Esophageal Carcinoma (2020 Edition)

Correlation of displacement of mediastinal metastatic lymph nodes with adjacent organs in non‐small cell lung cancer on four‐dimensional computed tomography

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