TY - JOUR
T1 - Selective mediastinal node irradiation in non-small cell lung cancer in the IMRT/VMAT era
T2 - How to use E(B)US-NA information in addition to PET–CT for delineation?
AU - Peeters, Stephanie T.
AU - Dooms, Christophe
AU - Van Baardwijk, Angela
AU - Dingemans, Anne Marie C.
AU - Martinussen, Hanneke
AU - Vansteenkiste, Johan
AU - Decaluwé, Herbert
AU - De Leyn, Paul
AU - Yserbyt, Jonas
AU - Nackaerts, Kristiaan
AU - De Wever, Walter
AU - Deroose, Christophe M.
AU - De Ruysscher, Dirk
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/8
Y1 - 2016/8
N2 - Background:FDG-PET–CT-based selective lymph node (LN) irradiation is standard using 3D-conformal techniques for locally advanced NSCLC. With newer techniques (intensity-modulated/volumetric-arc therapy (IMRT/VMAT)), the dose to non-involved adjacent LN decreases, which raises the question whether FDG-PET–CT-delineation is still safe. We therefore evaluated the impact of adding linear endosonography with needle aspiration (E(B)US-NA) to FDG-PET–CT in selective nodal irradiation. Methods:Based on literature data on sensitivity and specificity of E(B)US-NA in FDG-PET–CT-staged NSCLC, false negative (FN) rates for different constellations of CT, PET and E(B)US-NA were calculated. The algorithm was tested on consecutive patients with N2/N3 disease referred for radiotherapy in Leuven and Maastricht. Results:An algorithm determining when to include LN in the GTV is proposed, based on data from 5 meta-analyses. Adding E(B)US-NA to FDG-PET–CT decreases the FN-rate, but for PET-positive and E(B)US-negative LN, FN rates are still 14–16%. In Leuven 520 LN were analyzed, in Maastricht 364 LN; with E(B)US-NA a geographical miss was avoided in 2 (2/40 = 5%) and 1 (1/28 = 4%) patients, respectively. Conclusions:E(B)US-NA in addition to FDG-PET–CT for mediastinal staging decreases the risk of a geographical miss with 4–5%. The impact of this small decrease on survival is unknown. The proposed algorithm may guide the radiation oncologist when to include LN in the nodal GTV.
AB - Background:FDG-PET–CT-based selective lymph node (LN) irradiation is standard using 3D-conformal techniques for locally advanced NSCLC. With newer techniques (intensity-modulated/volumetric-arc therapy (IMRT/VMAT)), the dose to non-involved adjacent LN decreases, which raises the question whether FDG-PET–CT-delineation is still safe. We therefore evaluated the impact of adding linear endosonography with needle aspiration (E(B)US-NA) to FDG-PET–CT in selective nodal irradiation. Methods:Based on literature data on sensitivity and specificity of E(B)US-NA in FDG-PET–CT-staged NSCLC, false negative (FN) rates for different constellations of CT, PET and E(B)US-NA were calculated. The algorithm was tested on consecutive patients with N2/N3 disease referred for radiotherapy in Leuven and Maastricht. Results:An algorithm determining when to include LN in the GTV is proposed, based on data from 5 meta-analyses. Adding E(B)US-NA to FDG-PET–CT decreases the FN-rate, but for PET-positive and E(B)US-negative LN, FN rates are still 14–16%. In Leuven 520 LN were analyzed, in Maastricht 364 LN; with E(B)US-NA a geographical miss was avoided in 2 (2/40 = 5%) and 1 (1/28 = 4%) patients, respectively. Conclusions:E(B)US-NA in addition to FDG-PET–CT for mediastinal staging decreases the risk of a geographical miss with 4–5%. The impact of this small decrease on survival is unknown. The proposed algorithm may guide the radiation oncologist when to include LN in the nodal GTV.
UR - http://www.scopus.com/inward/record.url?scp=84991106957&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2016.05.023
DO - 10.1016/j.radonc.2016.05.023
M3 - Article
C2 - 27291644
AN - SCOPUS:84991106957
SN - 0167-8140
VL - 120
SP - 273
EP - 278
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 2
ER -
