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Radiation Oncology • Gastrointestinal Cancers
Do you include subcarinal, AP window, and mediastinal paraaortic nodes in your CTV for esophageal cancer?
ASTRO 2015 guidelines did not recommend coverage of stations 5/6/7 except for what is within 1 cm of the esophagus to limit lung dose. However, ARS 2020 guidelines recommend subcarinal nodes if GTV extends above carina or if paraesophageal CTV extends to the subcarinal axial plane. ARS 2020 also recommend coverage of mediastinal PA and AP window nodes if GTV is above carina. How do you reconcile the two different recommendations?
Answer from: Radiation Oncologist at Academic Institution
Unfortunately, this is essentially a data free zone. There are certainly no clinical trials to answer the question - it is hard enough to prove the value of radiation therapy without going into second order effects such as on the exact size of the RT field. I personally do not extend the fields prox...
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