Dosimetric comparison of nodal clinical target volume for locally advanced non‑small cell lung cancer: Options for geometric expansion vs. lymph node stations

Takahashi,Shigeo; Anada,Masahide; Kinoshita,Toshifumi; Nishide,Takamasa; Shibata,Toru

doi:10.3892/mco.2024.2755

Dosimetric comparison of nodal clinical target volume for locally advanced non‑small cell lung cancer: Options for geometric expansion vs. lymph node stations

Authors:
- Shigeo Takahashi
- Masahide Anada
- Toshifumi Kinoshita
- Takamasa Nishide
- Toru Shibata
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Affiliations: Department of Radiation Oncology, Kagawa University Hospital, Miki, Kagawa 761‑0793, Japan
Published online on: June 26, 2024 https://doi.org/10.3892/mco.2024.2755
Article Number: 57
Copyright: © Takahashi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The purpose of the present retrospective study was to evaluate whether dosimetric differences existed in nodal clinical target volume (CTV) using options for geometric expansion and lymph node (LN) stations based on the European Society for Radiotherapy and Oncology guideline for locally advanced non‑small cell lung cancer (NSCLC). In the treatment planning computed tomographic images of 17 patients with cT4N2M0 NSCLC, nodal CTVs were contoured based on the guideline options of: i) Geometric expansion, with CTV including the nodal gross tumor volume plus 5 mm margin; and ii) LN stations, with CTV including the affected LN stations. Treatment planning of 60 Gy in 30 fractions was performed using volumetric modulated arc therapy; D_mean was the mean irradiated dose to the structure; and V_nGy was the volume of the structure receiving ≥n Gy. Dose‑volume parameters were compared between the two options. Consequently, the option of geometric expansion was associated with a significantly lower V_60Gy and D_mean of the esophagus, V_20Gy, V_5Gy and D_mean of the lungs, and D_mean of the heart than the option of LN stations in all patients (P=0.017, P<0.001, P<0.001, P<0.001, P<0.001 and P=0.029, respectively). For the V_20Gy of the lungs, the 8 patients (47%) with LN metastases in stations 2 or 3 had significantly larger differences in the values between the two options than the 9 patients (53%) without those metastases; the median values of the difference of V_20Gy of the lungs between the two options were 2.8% (range, 0.2 to 9.6%) with LN metastases in stations 2 or 3 and 0.5% (range, ‑0.2 to 5.0%) without these metastases (P=0.027). In conclusion, using the option for geometric expansion might help reduce the V_60Gy and D_mean of the esophagus, V_20Gy, V_5Gy and D_mean of the lungs, and D_mean of the heart in all patients, and the V_20Gy of the lungs in patients with LN metastases in stations 2 or 3.

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1	Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I and Jemal A: Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 74:229–263. 2024.PubMed/NCBI View Article : Google Scholar
2	Kinoshita FL, Ito Y and Nakayama T: Trends in lung cancer incidence rates by histological type in 1975-2008: A population-based study in Osaka, Japan. J Epidemiol. 26:579–586. 2016.PubMed/NCBI View Article : Google Scholar
3	Aoun-Bacha Z, Bitar N, Saleh WA, Assi H, Bahous J, Boukhalil P, Chami H, Dabar G, El Karak F, Farhat F, et al: Diagnosis and management of patients with stage III non-small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review). Oncol Lett. 25(113)2023.PubMed/NCBI View Article : Google Scholar
4	Covington MF, Koppula BR, Fine GC, Salem AE, Wiggins RH, Hoffman JM and Morton KA: PET-CT in Clinical Adult Oncology: II. Primary Thoracic and Breast Malignancies. Cancers (Basel). 14(2689)2022.PubMed/NCBI View Article : Google Scholar
5	Balata H, Fong KM, Hendriks LE, Lam S, Ostroff JS, Peled N, Wu N and Aggarwal C: Prevention and early detection for NSCLC: Advances in thoracic oncology 2018. J Thorac Oncol. 14:1513–1527. 2019.PubMed/NCBI View Article : Google Scholar
6	Daly ME, Singh N, Ismaila N, Antonoff MB, Arenberg DA, Bradley J, David E, Detterbeck F, Früh M, Gubens MA, et al: Management of Stage III Non-Small-Cell Lung Cancer: ASCO Guideline. J Clin Oncol. 40:1356–1384. 2022.PubMed/NCBI View Article : Google Scholar
7	Simone CB II, Bradley J, Chen AB, Daly ME, Louie AV, Robinson CG, Videtic GMM and Rodrigues G: ASTRO radiation therapy summary of the ASCO guideline on management of stage III non-small cell lung cancer. Pract Radiat Oncol. 13:195–202. 2023.PubMed/NCBI View Article : Google Scholar
8	Bradley JD, Paulus R, Komaki R, Masters G, Blumenschein G, Schild S, Bogart J, Hu C, Forster K, Magliocco A, et al: Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): A randomised, two-by-two factorial phase 3 study. Lancet Oncol. 16:187–199. 2015.PubMed/NCBI View Article : Google Scholar
9	Bradley JD, Hu C, Komaki RR, Masters GA, Blumenschein GR, Schild SE, Bogart JA, Forster KM, Magliocco AM, Kavadi VS, et al: Long-Term Results of NRG Oncology RTOG 0617: Standard-versus high-dose chemoradiotherapy with or without cetuximab for unresectable stage III non-small-cell lung cancer. J Clin Oncol. 38:706–714. 2020.PubMed/NCBI View Article : Google Scholar
10	Spigel DR, Faivre-Finn C, Gray JE, Vicente D, Planchard D, Paz-Ares L, Vansteenkiste JF, Garassino MC, Hui R, Quantin X, et al: Five-Year survival outcomes from the PACIFIC Trial: Durvalumab after chemoradiotherapy in stage III Non-Small-Cell Lung Cancer. J Clin Oncol. 40:1301–1311. 2022.PubMed/NCBI View Article : Google Scholar
11	Palma DA, Senan S, Tsujino K, Barriger RB, Rengan R, Moreno M, Bradley JD, Kim TH, Ramella S, Marks LB, et al: Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: An international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 85:444–450. 2013.PubMed/NCBI View Article : Google Scholar
12	De Ruysscher D, Faivre-Finn C, Moeller D, Nestle U, Hurkmans CW, Le Péchoux C, Belderbos J, Guckenberger M and Senan S: Lung Group and the Radiation Oncology Group of the European Organization for Research and Treatment of Cancer (EORTC). European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer. Radiother Oncol. 124:1–10. 2017.PubMed/NCBI View Article : Google Scholar
13	Nestle U, De Ruysscher D, Ricardi U, Geets X, Belderbos J, Pöttgen C, Dziadiuszko R, Peeters S, Lievens Y, Hurkmans C, et al: ESTRO ACROP guidelines for target volume definition in the treatment of locally advanced non-small cell lung cancer. Radiother Oncol. 127:1–5. 2018.PubMed/NCBI View Article : Google Scholar
14	Itazawa T, Tamaki Y, Komiyama T, Nishimura Y, Nakayama Y, Ito H, Ohde Y, Kusumoto M, Sakai S, Suzuki K, et al: The Japan Lung Cancer Society-Japanese Society for Radiation Oncology consensus-based computed tomographic atlas for defining regional lymph node stations in radiotherapy for lung cancer. J Radiat Res. 58:86–105. 2017.PubMed/NCBI View Article : Google Scholar
15	Gospodarowicz MK, Wittekind C and Brierley JD (eds): Lung. In: TNM Classification of Malignant Tumours. 8th edition. Wiley-Blackwell, New Jersey, pp106-112, 2016.
16	Wang K, Eblan MJ, Deal AM, Lipner M, Zagar TM, Wang Y, Mavroidis P, Lee CB, Jensen BC, Rosenman JG, et al: Cardiac toxicity after radiotherapy for stage III non-small-cell lung cancer: Pooled analysis of dose-escalation trials delivering 70 to 90 gy. J Clin Oncol. 35:1387–1394. 2017.PubMed/NCBI View Article : Google Scholar
17	Cui T, Zhang A, Cui J, Chen L, Chen G, Dai H, Qin X, Li G and Sun J: Feasibility of omitting the clinical target volume under PET-CT guidance in unresectable stage III non-small-cell lung cancer: A phase II clinical trial. Radiother Oncol. 181(109505)2023.PubMed/NCBI View Article : Google Scholar
18	Yuan S, Sun X, Li M, Yu J, Ren R, Yu Y, Li J, Liu X, Wang R, Li B, et al: A randomized study of involved-field irradiation versus elective nodal irradiation in combination with concurrent chemotherapy for inoperable stage III nonsmall cell lung cancer. Am J Clin Oncol. 30:239–244. 2007.PubMed/NCBI View Article : Google Scholar