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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/22539

Title: Patterns of Locoregional Relapses in Patients with Contemporarily Staged Stage III-N2 NSCLC Treated with Induction Chemotherapy and Resection: Implications for Postoperative Radiotherapy Target Volumes
Authors: Billiet, Charlotte
De Ruysscher, Dirk
Peeters, Stéphanie
Decaluwé, Herbert
Vansteenkiste, Johan
Dooms, Christophe
Deroose, Christophe M.
De Leyn, Paul
Hendrikx, Marc
Bulens, Paul
Le Péchoux, Cécile
Mebis, Jeroen
Issue Date: 2016
Publisher: ELSEVIER SCIENCE INC
Citation: Journal of Thoracic Oncology, 11(9), p. 1538-1549
Abstract: Objectives: Our aim was to evaluate locoregional relapse (LR) patterns after induction chemotherapy and surgery for stage III-N2 NSCLC staged with current standard methods and their impact on radiation target volumes for postoperative radiotherapy (PORT). Methods: A total of 150 patients with stage III-N2 NSCLC from a prospective database of patients who underwent surgical resection at the University Hospitals of Leuven or the Oncologic Centre Limburg between 1998 and 2012 were included. Patients were staged with fluorodeoxyglucose F 18 positron emission tomography/computed tomography and brain imaging and treated with induction chemotherapy and surgery. PORT was performed for incomplete resection (R1/R2) and/or persistent nodal disease (ypN2). For the non-PORT group, we created a virtual planning target volume (PTV). In general, the clinical target volume encompassed the bronchial stump, the ipsilateral hilum, the subcarinal region (station 7), and the initially involved mediastinal lymph nodes. Results: After a mean follow-up time of 49 months, the 5-year overall survival was 35.1% in all patients; disease free survival was 31.8%. PORT was delivered to 70 patients. LR was seen in 26 patients in the PORT group (37%) and 32 in the non-PORT group (40%). Fifty-eight nodal relapse sites were seen in the PORT group (2.2 sites per patient) versus 113 in the non-PORT group (3.5 sites per patient) (p < 0.01). In the PORT group, the most frequent sites of LR were the ipsilateral hilum (21%), lymph node station 7 (15%), ipsilateral station 4 (9%), ipsilateral station 5 (9%) and ipsilateral station 6 (9%). For the non PORT group these were station 7 (19%), ipsilateral 4 (16%), and ipsilateral hilum (14%). The dominant pattern of failure was inside (inside or both inside and outside) the PTV. Regarding the out-of-PTV relapses, 47% and 69% of LRs occurred in the contralateral mediastinum for the PORT and non-PORT groups, respectively. Out-of-PTV relapses occurred mostly in initially left-sided tumors. Conclusions: Despite the limitations of this retrospective study, our data support the role of PORT in decreasing local relapses. Because of the large number of out-of-PTV relapses in the contralateral mediastinum, inclusion of elective contralateral lymph node stations in the PTV could be considered in left-sided tumors. However, prospective randomized trials are needed to verify this.
Notes: [Billiet, Charlotte; Peeters, Stephanie] Univ Leuven, Katholieke Univ Leuven, Dept Radiat Oncol, Leuven, Belgium. [Billiet, Charlotte; Hendrikx, Marc; Mebis, Jeroen] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. [De Ruysscher, Dirk] Univ Leuven, Katholieke Univ Leuven, Dept Oncol, Expt Radiat Oncol, Leuven, Belgium. [De Ruysscher, Dirk] Maastricht Univ, Med Ctr, GROW, Dept Radiat Oncol, Maastricht, Netherlands. [Decaluwe, Herbert; De Leyn, Paul] Univ Leuven, Dept Thorac Surg, Leuven, Belgium. [Decaluwe, Herbert; Vansteenkiste, Johan; Dooms, Christophe; De Leyn, Paul] Univ Leuven, Katholieke Univ Leuven, Leuven Lung Canc Grp, Leuven, Belgium. [Vansteenkiste, Johan; Dooms, Christophe] Univ Leuven, Dept Resp Oncol Pneumol, Leuven, Belgium. [Deroose, Christophe M.] Univ Leuven, Katholieke Univ Leuven, Dept Imaging & Pathol Nucl Med & Mol Imaging, Leuven, Belgium. [Hendrikx, Marc] Jessa Hosp, Dept Cardiothorac Surg, Hasselt, Belgium. [Bulens, Paul] Jessa Hosp, Dept Radiat Oncol, Stadsomvaart 11, B-3500 Hasselt, Belgium. [Le Pechoux, Cecile] Inst Gustave Roussy, Dept Radiat Oncol, Villejuif, France. [Mebis, Jeroen] Jessa Hosp, Dept Med Oncol, Hasselt, Belgium.
URI: http://hdl.handle.net/1942/22539
DOI: 10.1016/j.jtho.2016.05.037
ISI #: 000382420200020
ISSN: 1556-0864
Category: A1
Type: Journal Contribution
Validation: ecoom, 2017
Appears in Collections: Research publications

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