Residual Tumor After Neoadjuvant Chemoradiation Outside the Radiation Therapy Target Volume: A New Prognostic Factor for Survival in Esophageal Cancer

Christina Muijs*, Justin Smit, Arend Karrenbeld, J.C. Beukema, Veronique Mul, Go van Dam, Geke Hospers, Phillip Kluin, Johannes Langendijk, John Plukker

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)


Purpose/Objective(s): The aim of this study was to analyze the accuracy of gross tumor volume (GTV) delineation and clinical target volume (CTV) margins for neoadjuvant chemoradiation therapy (neo-CRT) in esophageal carcinoma at pathologic examination and to determine the impact on survival.

Methods and Materials: The study population consisted of 63 esophageal cancer patients treated with neo-CRT. GTV and CTV borders were demarcated in situ during surgery on the esophagus, using anatomical reference points to provide accurate information regarding tumor location at pathologic evaluation. To identify prognostic factors for disease-free survival (DFS) and overall survival (OS), a Cox regression analysis was performed.

Results: After resection, macroscopic residual tumor was found outside the GTV in 7 patients (11%). Microscopic residual tumor was located outside the CTV in 9 patients (14%). The median follow-up was 15.6 months. With multivariate analysis, only microscopic tumor outside the CTV (hazard ratio [HR], 4.96; 95% confidence interval [CI], 1.03-15.36), and perineural growth (HR, 5.77; 95% CI, 1.27-26.13) were identified as independent prognostic factors for OS. The 1-year OS was 20% for patients with tumor outside the CTV and 86% for those without (P

Conclusions: Microscopic tumor outside the CTV is associated with markedly worse OS after neo-CRT. This may either stress the importance of accurate tumor delineation or reflect aggressive tumor behavior requiring new adjuvant treatment modalities. (C) 2014 Elsevier Inc.

Original languageEnglish
Pages (from-to)845-852
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number4
Publication statusPublished - 15-Mar-2014


  • Adenocarcinoma
  • Adult
  • Aged
  • Aged, 80 and over
  • Anatomic Landmarks
  • Antineoplastic Combined Chemotherapy Protocols
  • Carboplatin
  • Carcinoma, Squamous Cell
  • Chemotherapy, Adjuvant
  • Disease-Free Survival
  • Esophageal Neoplasms
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neoplasm, Residual
  • Paclitaxel
  • Prognosis
  • Prospective Studies
  • Radiotherapy Planning, Computer-Assisted
  • Regression Analysis
  • Tumor Burden


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