Variations in Target Volume Definition for Postoperative Radiotherapy in Stage III Non–Small-Cell Lung Cancer: Analysis of an International Contouring Study

Spoelstra, F.; Senan, Suresh; Péchoux, C. Le; Ishikura, Satoshi; Casas, Francesc; Ball, David; Price, Allan; Ruysscher, Dirk De; Koste, John R. van Sörnsen de

doi:10.1016/j.ijrobp.2009.02.072

Cited by 98 publications

(84 citation statements)

References 34 publications

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“…Thus, if one considers a series of surgical patients with pN2 nodal disease, the risk for lymph node involvement is 48% around the trachea and 41% in the subcarenal region [70]. Consequently, paratracheal nodes, subcarenal nodes, as well as the homolateral hilar region should be systematically included in the irradiation volume [71,72]. A recent study has shown that there are wide variations in target volume definition for PORT even among TRT oncologists [71].…”

Section: Implications For a New Trial Evaluating Portmentioning

confidence: 99%

“…Consequently, paratracheal nodes, subcarenal nodes, as well as the homolateral hilar region should be systematically included in the irradiation volume [71,72]. A recent study has shown that there are wide variations in target volume definition for PORT even among TRT oncologists [71]. Based on previous studies, it seems reasonable to treat only involved lymph node stations and uninvolved stations at high risk to better protect surrounding normal structures and consequently minimize treatment-related mortality [40,50,72,73,74].…”

Section: Implications For a New Trial Evaluating Portmentioning

confidence: 99%

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Role of Postoperative Radiotherapy in Resected Non-Small Cell Lung Cancer: A Reassessment Based on New Data

Péchoux

2011

The Oncologist

117

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After completing this course, the reader will be able to: 1. Identify patients with non-small cell lung cancer who may benefit from postoperative radiotherapy based upon current evidence. 2. Summarize the results of analyses of both older and more recent data regarding postoperative radiotherapy in NSCLC patients. ABSTRACT In completely resected non-small cell lung cancer (NSCLC) patients with pathologically involved mediasti-nal lymph nodes (N2), administration of adjuvant platinum based chemotherapy is now considered the standard of care, based on level 1 evidence. The role of postoperative radiation therapy (PORT) in this group of patients remains controversial. The PORT meta-analysis published in 1998 concluded that adjuvant radiotherapy was detrimental to patients with early-stage completely resected NSCLC, but that the role of PORT in the treatment of tumors with N2 involvement was unclear, and that further research was warranted. Recent retrospective and non-randomized studies, as well as subgroup analyses of recent randomized trials evaluating adjuvant chemotherapy, provide evidence of the possible benefit of PORT in patients with mediastinal nodal involvement. The role of PORT is also a valid question in patients with proven N2 disease who have undergone only induction chemotherapy followed by surgery, because the local recurrence rate for such patients varies in the range of 20%-60%. Based on the currently available data, PORT should be discussed for fit patients with completely resected NSCLC with N2 nodal involvement, preferably after completion of adju-vant chemotherapy. There is a need for new randomized evidence to evaluate PORT using the modern three-dimensional conformal radiation technique, with attention paid to reducing the risk for, particularly, pulmonary and cardiac toxicity. A new large multi-institutional randomized trial evaluating PORT in this patient population is needed and now under way. The Oncologist 2011;16:672-681

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Section: Implications For a New Trial Evaluating Portmentioning

confidence: 99%

Section: Implications For a New Trial Evaluating Portmentioning

confidence: 99%

Role of Postoperative Radiotherapy in Resected Non-Small Cell Lung Cancer: A Reassessment Based on New Data

Péchoux

2011

The Oncologist

117

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“…For the latter, one common approach is the "one-up, one-down" contouring technique (e.g., one lymph node station below, one above on the ipsilateral side). The ongoing LungArt trial, which examines the role of PORT in N2 disease, utilizes this general technique, with the recommendations varying by the laterality of the primary tumor due to differences in nodal drainage (Spoelstra et al 2010 ) (Table 2 ).…”

Section: -Target Volumesmentioning

confidence: 99%

Stereotactic Ablative Body Radiation (SABR) and Postoperative Radiation in Non-Small Cell Lung Cancer (NSCLC)

Gomez

Balter

Liao

2014

Target Volume Delineation for Conformal and Intensity-Modulated Radiation Therapy

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“…One of the concerns in retrospective series presenting PORT such as in this manuscript is the variability of PORT target volume definition, especially in a wide range of years treated by different physicians, such as documented by different cohorts (11,12). The objective evaluation of PORT reveals a significant survival benefit for N2 disease independent from chemotherapy, while a local regional control assistance in patients with N1 disease who do not receive chemotherapy (4,(13)(14)(15)(16)(17).…”

mentioning

confidence: 98%

“…It would not be wrong to note the major problem in all older trials with deaths due to radiotherapy technical weaknesses which avoided local regional control effect turning out into a survival benefit (15). The phase 3 trial of "The Lung Adjuvant Radiotherapy (Lung ART)" enrolling N2 disease into PORT with modern and standardized techniques is expected to shed light on the gray zone in a prospective manner (12,18,19).…”

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confidence: 99%

Optimal sequencing of postoperative radiotherapy and chemotherapy in IIIA-N2 non-small cell lung cancer

Selek¹,

Chang²

2016

J. Thorac. Dis.

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Variations in Target Volume Definition for Postoperative Radiotherapy in Stage III Non–Small-Cell Lung Cancer: Analysis of an International Contouring Study

Cited by 98 publications

References 34 publications

Role of Postoperative Radiotherapy in Resected Non-Small Cell Lung Cancer: A Reassessment Based on New Data

Role of Postoperative Radiotherapy in Resected Non-Small Cell Lung Cancer: A Reassessment Based on New Data

Stereotactic Ablative Body Radiation (SABR) and Postoperative Radiation in Non-Small Cell Lung Cancer (NSCLC)

Optimal sequencing of postoperative radiotherapy and chemotherapy in IIIA-N2 non-small cell lung cancer

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