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Review
. 2016 Jan 1;7(2):200-6.
doi: 10.7150/jca.13873. eCollection 2016.

What Is the Appropriate Clinical Target Volume for Esophageal Squamous Cell Carcinoma? Debate and Consensus Based on Pathological and Clinical Outcomes

Dali Han  1 , Yinping Yuan  2 , Xuqing Song  3 , Yonghua Yu  1 , Jinming Yu  1
Affiliations
Review

What Is the Appropriate Clinical Target Volume for Esophageal Squamous Cell Carcinoma? Debate and Consensus Based on Pathological and Clinical Outcomes

Dali Han et al. J Cancer. .

Abstract

Accurate delineation of clinical target volume (CTV) is critical in the effective management of squamous cell carcinoma (SCC) of esophagus using radiation therapy. Accurate delineation may improve the probability of local control and reduce the risk of complications. However, there are no consistent standards on the proper size of the margins added to the gross tumor volume (GTV). Different institutions and radiation oncologists have discordant opinions. In this paper, we review pathological and clinical outcomes to determine the most appropriate CTV for squamous cell carcinomas (SCC) of esophagus. The CTV for esophageal carcinoma should ensure that all subclinical lesions are encompassed regardless of the physical distance. The most precise method for delineating a reasonable CTV is to combine advanced imaging techniques, such as PET/CT and EUS, which allows the detection and prediction of subclinical lesions based on tumor characteristics such as the pathological type, differentiation, T disease, length and lymph node status.

Keywords: clinical target volume; esophageal squamous cell carcinoma; radiation therapy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Treatment planning simulated with FLT and FDG positron emission tomography (PET)/computed tomography (CT) for a 72-year-old male patient with upper thoracic esophageal SCC. a. FLT PET/CT image based 7-beam IMRT irradiation field including primary tumor and prophylactic supraclavicular nodes region (SUV=1.4, LTumor=4.68 cm, GTV=15.95 cm3, PTV=650.33 cm3),B. FDG PET/CT image based 7-beam IMRT irradiation field including primary tumor and prophylactic supraclavicular nodes region (SUV=2.5, LTumor=5.1 cm, GTV=17.19 cm3, PTV=708.21 cm3). The difference between FLT and FDG PET/CT induced GTV is only 1.24 cm3, while that's of PTV is 57.88 cm3. It has shown that with even with a little larger GTV, will affect the PTV significantly, and also will influence organ-at-risk (OAR) as a induced result. (Cited from reference 22, with permission by Elsevier.)
Figure 2
Figure 2
Rate of LNM to different regions according to the location of the primary tumor (Cited from reference 29, with permission by Elsevier.)
See this image and copyright information in PMC

References

    1. Cooper JS, Guo MD, Herskovic A. et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA. 1999;281:1623–7. - PubMed
    1. Minsky BD, Pajak TF, Ginsberg RJ. et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002;20:1167–74. - PubMed
    1. Kuwano H, Masuda N, Kato H. et al. The subepithelial extension of esophageal carcinoma for determining the resection margin during esophagectomy: a serial histopathologic investigation. Surgery. 2002;131(Suppl 1):S14–21. - PubMed
    1. Tsutsui S, Kuwano H, Watanabe M. et al. Resection margin for squamous cell carcinoma of the esophagus. Ann Surg. 1995;222:193–202. - PMC - PubMed
    1. Nishimaki T, Suzuki T, Tanaka Y. et al. Intramural metastases from thoracic esophageal cancer: local indicators of advanced disease. World J Surg. 1996;20:32–7. - PubMed