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Vendrely V, Lemanski C, Pommier P, LE Malicot K, Saint A, Rivin Del Campo E, Regnault P, Baba-Hamed N, Ronchin P, Crehange G, Tougeron D, Menager-Tabourel E, Diaz O, Hummelsberger M, Minsat M, Drouet F, Larrouy A, Peiffert D, Lievre A, Zasadny X, Hautefeuille V, Mornex F, Lepage C, Quero L. Treatment, outcome, and prognostic factors in non-metastatic anal cancer: The French nationwide cohort study FFCD-ANABASE. Radiother Oncol 2023; 183:109542. [PMID: 36813175 DOI: 10.1016/j.radonc.2023.109542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION International guidelines regarding the treatment of squamous cell carcinoma of the anus (SCCA) recommend intensity-modulated radiotherapy (IMRT) combined with mitomycin-based chemotherapy (CT). The French FFCD-ANABASE cohort aimed at evaluating clinical practices, treatment, and outcomes of SCCA patients. METHODS This prospective multicentric observational cohort included all non-metastatic SCCA patients treated in 60 French centers from January 2015 to April 2020. Patients and treatment characteristics, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed. RESULTS Among 1015 patients (male: 24.4 %; female: 75.6 %; median age: 65 years), 43.3 %presented with early-stage(T1-2, N0) and 56.7 % with locally advanced stage (T3-4 or N + ) tumors. IMRT was used for 815 patients (80.3 %) and a concurrent CT was administered in 781 patients, consisting of mitomycin-based CT for 80 %. The median follow-up was 35.5 months. DFS, CFS, and OS at 3 years were 84.3 %, 85.6 %, and 91.7 % respectively in the early-stage group compared to 64.4 %, 66.9 %, and 78.2 % in the locally-advanced group (p < 0.001). In multivariate analyses, male gender, locally-advanced stage, and ECOG PS ≥ 1 were associated with poorer DFS, CFS, and OS. IMRT was significantly associated with a better CFS in the whole cohort and almost reached significance in the locally-advanced group. CONCLUSION Treatment of SCCA patients showed good respect for current guidelines. Significant differences in outcomes advocate for personalized strategies by either de-escalation for early-stage tumors or treatment intensification for locally-advanced tumors.
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Affiliation(s)
- Véronique Vendrely
- Department of Radiation Oncology, CHU Bordeaux, Bordeaux, France; BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France.
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France
| | | | - Karine LE Malicot
- Fédération Francophone de Cancérologie Digestive, university of Burgundy, Biostatistics, Dijon, France; EPICAD INSERM LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Angélique Saint
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, Oncology, Nice, France
| | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, APHP, Sorbonne University, Paris, France
| | | | | | | | - Gilles Crehange
- Radiotherapy department, Georges François Leclerc cancer center, Dijon, France
| | - David Tougeron
- Hepatology and Gastroenterology department, Poitiers University hospital, Poitiers, France
| | | | - Olivia Diaz
- Radiotherapy department, Daniel Hollard Institute, Grenoble, France
| | | | | | | | - Anne Larrouy
- Médical Oncology, Cancer institute, North Paris, France
| | - Didier Peiffert
- Department of radiaton oncology, Lorraine cancer center, Vandoeuvre-Les-Nancy, France
| | - Astrid Lievre
- Gastroenterology Department, Rennes University Hospital, Rennes 1 University, Inserm U1242 COSS (Chemistry Oncogenesis Stress Signaling, Rennes, France
| | - Xavier Zasadny
- Oncology radiotherapy department, Limoges polyclinic François Chenieux, Limoges, France
| | | | | | - Côme Lepage
- Department of hepato-gastroenterology, University hospital of Dijon, Dijon, France
| | - Laurent Quero
- INSERM U1160, Université Paris Cité, Paris, France; Radiotherapy Saint Louis Hospital, APHP, Paris, France
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Larrouy A, Giraud N, Huguet F, Vendrely V. [Organ preservation for rectal cancer: What are the arguments in favor of radiotherapy?]. Cancer Radiother 2022; 26:766-770. [PMID: 35995720 DOI: 10.1016/j.canrad.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
Standard care for rectal cancers relies on both tumor (location relative to the sphincter, T and N stage, sphincter involvement) and patients characteristics. Radical surgery (total mesorectal excision) following short-course radiotherapy (RT) or standard chemo-radiotherapy, associated with induction or consolidation chemotherapy (total neoadjuvant treatment), remains the cornerstone of locally advanced rectal cancer (T3cd, T4 and/or N+) treatment. Nevertheless, for early stages, this radical resection could be avoided in favor of conservative approaches combining RT (external, contact, brachytherapy) with or without chemotherapy (concurrent, induction or consolidative), or even be limited, for good responders, to a local excision with view of organ-preservation strategies. This conservative approach could also be offered selectively to patients with complete clinical response after the induction sequence, irrespective of initial tumor characteristics. The Watch and Wait strategy relies on clinical, endoscopic and radiological evaluations, as well as sustained surveillance. Ongoing studies aim to improve response rates, either with chemotherapy intensification, or RT boost dose escalation with brachytherapy or contact-therapy.
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Affiliation(s)
- A Larrouy
- Institut cancérologie Paris Nord, service d'oncologie radiothérapie, avenue Charles-Péguy, 95200 Sarcelles, France.
| | - N Giraud
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - F Huguet
- Assistance publique-Hôpitaux de Paris, service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, Paris, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; U1312-BRIC, eq BioGO, Inserm, université de Bordeaux, 33000 Bordeaux, France
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Le Pechoux C, Pourel N, Barlesi F, Lerouge D, Antoni D, Lamezec B, Nestle U, Boisselier P, Dansin E, Paumier A, Peignaux K, Thillays F, Zalcman G, Madelaine J, Pichon E, Larrouy A, Lavole A, Argo-Leignel D, Derollez M, Faivre-Finn C, Hatton MQ, Riesterer O, Bouvier-Morel E, Dunant A, Edwards JG, Thomas PA, Mercier O, Bardet A. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:104-114. [PMID: 34919827 DOI: 10.1016/s1470-2045(21)00606-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND In patients with non-small-cell lung cancer (NSCLC), the use of postoperative radiotherapy (PORT) has been controversial since 1998, because of one meta-analysis showing a deleterious effect on survival in patients with pN0 and pN1, but with an unclear effect in patients with pN2 NSCLC. Because many changes have occurred in the management of patients with NSCLC, the role of three-dimensional (3D) conformal PORT warrants further investigation in patients with stage IIIAN2 NSCLC. The aim of this study was to establish whether PORT should be part of their standard treatment. METHODS Lung ART is an open-label, randomised, phase 3, superiority trial comparing mediastinal PORT to no PORT in patients with NSCLC with complete resection, nodal exploration, and cytologically or histologically proven N2 involvement. Previous neoadjuvant or adjuvant chemotherapy was allowed. Patients aged 18 years or older, with an WHO performance status of 0-2, were recruited from 64 hospitals and cancer centres in five countries (France, UK, Germany, Switzerland, and Belgium). Patients were randomly assigned (1:1) to either the PORT or no PORT (control) groups via a web randomisation system, and minimisation factors were the institution, administration of chemotherapy, number of mediastinal lymph node stations involved, histology, and use of pre-treatment PET scan. Patients received PORT at a dose of 54 Gy in 27 or 30 daily fractions, on five consecutive days a week. Three dimensional conformal radiotherapy was mandatory, and intensity-modulated radiotherapy was permitted in centres with expertise. The primary endpoint was disease-free survival, analysed by intention to treat at 3 years; patients from the PORT group who did not receive radiotherapy and patients from the control group with no follow-up were excluded from the safety analyses. This trial is now closed. This trial is registered with ClinicalTrials.gov number, NCT00410683. FINDINGS Between Aug 7, 2007, and July 17, 2018, 501 patients, predominantly staged with 18F-fluorodeoxyglucose (18F-FDG) PET (456 [91%]; 232 (92%) in the PORT group and 224 (90%) in the control group), were enrolled and randomly assigned to receive PORT (252 patients) or no PORT (249 patients). At the cutoff date of May 31, 2019, median follow-up was 4·8 years (IQR 2·9-7·0). 3-year disease-free survival was 47% (95% CI 40-54) with PORT versus 44% (37-51) without PORT, and the median disease-free survival was 30·5 months (95% CI 24-49) in the PORT group and 22·8 months (17-37) in the control group (hazard ratio 0·86; 95% CI 0·68-1·08; p=0·18). The most common grade 3-4 adverse events were pneumonitis (13 [5%] of 241 patients in the PORT group vs one [<1%] of 246 in the control group), lymphopenia (nine [4%] vs 0), and fatigue (six [3%] vs one [<1%]). Late-grade 3-4 cardiopulmonary toxicity was reported in 26 patients (11%) in the PORT group versus 12 (5%) in the control group. Two patients died from pneumonitis, partly related to radiotherapy and infection, and one patient died due to chemotherapy toxicity (sepsis) that was deemed to be treatment-related, all of whom were in the PORT group. INTERPRETATION Lung ART evaluated 3D conformal PORT after complete resection in patients who predominantly had been staged using (18F-FDG PET-CT and received neoadjuvant or adjuvant chemotherapy. 3-year disease-free survival was higher than expected in both groups, but PORT was not associated with an increased disease-free survival compared with no PORT. Conformal PORT cannot be recommended as the standard of care in patients with stage IIIAN2 NSCLC. FUNDING French National Cancer Institute, Programme Hospitalier de Recherche Clinique from the French Health Ministry, Gustave Roussy, Cancer Research UK, Swiss State Secretary for Education, Research, and Innovation, Swiss Cancer Research Foundation, Swiss Cancer League.
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Affiliation(s)
- Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
| | - Nicolas Pourel
- Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Aix-Marseille University, Centre National de la Recherche Scientifique, Institut National des Sciences et de la Recherche Médicale, Centre de Recherche en Cancérologie de Marseille, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Delphine Antoni
- Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France
| | - Bruno Lamezec
- Radiation Oncology, Centre Armoricain de Radiothérapie, d'Imagerie médicale et d'Oncologie, St Brieuc, France
| | - Ursula Nestle
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Pierre Boisselier
- Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Amaury Paumier
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest Centre Paul Papin, Angers, France
| | - Karine Peignaux
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Gerard Zalcman
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France; Department of Thoracic Oncology, Université de Paris, Centre d'Investigation Clinique-1425-Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jeannick Madelaine
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Eric Pichon
- Department of Pneumology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Larrouy
- Radiation Oncology, Centre Specialisé Cancerologie Paris Nord, Sarcelles, France
| | - Armelle Lavole
- Department of Thoracic Oncology, Tenon University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Marc Derollez
- Pneumology, Polyclinique du Val de Sambre, Maubeuge, France
| | - Corinne Faivre-Finn
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Q Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich and Centre for Radiation Oncology, Cantonal Hospitals Aarau and Baden, Aarau, Switzerland
| | - Emilie Bouvier-Morel
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Ariane Dunant
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Hôpital Nord, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Institut d'Oncologie Thoracique, Marie-Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France
| | - Aurelie Bardet
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France; Oncostat Unité Mixte de Recherche 1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
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Teixeira RC, Larrouy A, Muni A, Lachaud L, Raimond JM, Gleyzes S, Brune M. Preparation of Long-Lived, Non-Autoionizing Circular Rydberg States of Strontium. Phys Rev Lett 2020; 125:263001. [PMID: 33449789 DOI: 10.1103/physrevlett.125.263001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Alkaline earth Rydberg atoms are very promising tools for quantum technologies. Their highly excited outer electron provides them with the remarkable properties of Rydberg atoms and, notably, with a huge coupling to external fields or to other Rydberg atoms while the ionic core retains an optically active electron. However, low angular-momentum Rydberg states suffer almost immediate autoionization when the core is excited. Here, we demonstrate that strontium circular Rydberg atoms with a core excited in a 4D metastable level are impervious to autoionization over more than a few millisecond time scale. This makes it possible to trap and laser-cool Rydberg atoms. Moreover, we observe singlet to triplet transitions due to the core optical manipulations, opening the way to a microwave to optical quantum interface.
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Affiliation(s)
- R C Teixeira
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
- Departamento de Física, Universidade Federal de São Carlos, Rodovia Washington Luís, km 235-SP-310, 13565-905 São Carlos, São Paulo, Brazil
| | - A Larrouy
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
| | - A Muni
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
| | - L Lachaud
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
| | - J-M Raimond
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
| | - S Gleyzes
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
| | - M Brune
- Laboratoire Kastler Brossel, Collège de France, CNRS, ENS-Université PSL, Sorbonne Université, 11, place Marcelin Berthelot, 75005 Paris, France
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Des Guetz G, Landre T, Larrouy A, Panis Y, Morere JF, Mathonnet M, Quero L. Is there a benefit of oxaliplatin in neoadjuvant treatment of locally advanced rectal cancer? An updated meta-analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4098 Background: Neoadjuvant fluoropyrimidine (5FU or capecitabine)-based chemoradiotherapy (CRT) has been considered the standard of care for locally advanced rectal cancer (LARC). Whether addition of oxaliplatin (OXP) will further improve clinical outcomes is still unclear. Methods: To identify clinical trials combining oxaliplatin in preoperative CRT or perioperative chemotherapy for LARC published until December 2019, we searched PubMed, the Cochrane Library. We also search for relevant ASCO conferences. Primary endpoint was Disease-Free-Survival (DFS). Data were extracted from every study to perform a meta-analysis using Review Manager (version 5.3). Results: A total of 7 Randomized Clinical Trials (ACCORD-12, CARO-AIO-04, FOWARC, JIAO, NSABP, PETACC-6 and STAR-01) with 5782 stage II or III rectal cancer patients were analysed, including 2727 patients with OXP + 5FU regimen and 3055 patients with 5FU alone regimen. Compared with 5FU-based regimen group, OXP-based regimen group improved DFS (HR = 0.90, 95% CI: 0.81−0.99, P = 0.03) and increased pathologic Complete Response (OR = 1.21, 95% CI: 1.07−1.37, P = 0.002). Patients treated with OXP-regimen had significantly less metastatic disease (OR = 0.79; 95% CI, 0.67 to 0.94; p = 0.007). Considering Adverse Events (AEs), there was more grade 3-4 diarrhoea with OXP (OR = 2.41, 95% CI: 1.74−3.32, P < 0.00001). However, there were no significant differences grade 3-4 haematologic AEs (OR = 1.16, 95% CI: 0.87−1.57, P = 0.31). Conclusions: Combining oxaliplatin with capecitabine or 5FU in preoperative chemoradiotherapy or perioperative chemotherapy seems beneficial significantly and improved DFS. It remains necessary to identify which patients benefit most from the addition of oxaliplatin.
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Affiliation(s)
| | | | - Anne Larrouy
- Institut Cancérologie Paris Nord, Sarcelles, France
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Goldwasser F, Nisenbaum N, Vinant P, Balladur E, Dauchy S, Farota-Romejko I, Colombet I, Alby ML, Giroux J, Larrouy A, Destaintot E, Garcon L, Legrand D, Marin I. La réunion de concertation pluridisciplinaire onco-palliative : objectifs et préconisations pratiques. Bull Cancer 2018; 105:458-464. [DOI: 10.1016/j.bulcan.2018.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 12/25/2022]
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Laporte C, Larrouy A, Housset M. [External beam radiotherapy and brachytherapy in prostate cancer]. Rev Prat 2003; 53:2253-7. [PMID: 15018079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
For the last 10 years, along with surgery, radiotherapy has become a major issue in the curative treatment of prostate cancer. Several radiotherapy techniques can be used. In good prognosis cancers, when the prostate is small, brachytherapy is one of the therapeutic options. By implanting radioactive seeds within the prostate, this technique permits strictly limited intraprostatic irradiation. Conformal external beam (3D) radiotherapy adapts to individual morphology according to dosimetric CT scan data. This is particularly useful to deliver a high dose in the target volume while limiting the dose in surrounding organs. It is indicated either for localised tumours as an alternative solution to surgery, or for tumours with more aggressive patterns or locally advanced that will in both cases require adjuvant hormotherapy; conventional (2D) radiotherapy can be used in case of isolated clinical or biological relapse after prostatectomy. These last two techniques induce two main types of late toxicity: radio-induced rectitis and sexual impotence. Last but not least, radiotherapy as well as nuclear medicine can be used with palliation intent and may be of great help to relieve pain in case of bone metastases.
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Affiliation(s)
- Cyril Laporte
- Service d'oncologie radiothérapie, Hôpital européen Georges Pompidou, 75908 Paris 15.
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Giraud P, Antoine M, Larrouy A, Milleron B, Callard P, De Rycke Y, Carette MF, Rosenwald JC, Cosset JM, Housset M, Touboul E. Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning. Int J Radiat Oncol Biol Phys 2000; 48:1015-24. [PMID: 11072158 DOI: 10.1016/s0360-3016(00)00750-1] [Citation(s) in RCA: 354] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE One of the most difficult steps of the three-dimensional conformal radiotherapy (3DCRT) is to define the clinical target volume (CTV) according to the degree of local microscopic extension (ME). In this study, we tried to quantify this ME in non-small-cell lung cancer (NSCLC). MATERIAL AND METHODS Seventy NSCLC surgical resection specimens for which the border between tumor and adjacent lung parenchyma were examined on routine sections. This border was identified with the naked eye, outlined with a marker pen, and the value of the local ME outside of this border was measured with an eyepiece micrometer. The pattern of histologic spread was also determined. RESULTS A total of 354 slides were examined, corresponding to 176 slides for adenocarcinoma (ADC) and 178 slides for squamous cell carcinoma (SCC). The mean value of ME was 2.69 mm for ADC and 1.48 mm for SCC (p = 0.01). The usual 5-mm margin covers 80% of the ME for ADC and 91% for SCC. To take into account 95% of the ME, a margin of 8 mm and 6 mm must be chosen for ADC and SCC, respectively. Aerogenous dissemination was the most frequent pattern observed for all groups, followed by lymphatic invasion for ADC and interstitial extension for SCC. CONCLUSION The ME was different between ADC and SCC. The usual CTV margin of 5 mm appears inadequate to cover the ME for either group, and it must be increased to 8 mm and 6 mm for ADC and SCC, respectively, to cover 95% of the ME. This approach is obviously integrated into the overall 3DCRT procedure and with other margins.
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Affiliation(s)
- P Giraud
- Department of Radiation Oncology, Hôpital Tenon, Paris, France.
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