Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes

Smith Apisarnthanarax, Danielle D. Elliott, Adel K. El-Naggar, Joshua A. Asper, Angel Blanco, K. Kian Ang, Adam S. Garden, William H. Morrison, David Rosenthal, Randal S. Weber, K. S.Clifford Chao

Research output: Contribution to journalArticle

64 Scopus citations

Abstract

Purpose: To determine the optimal clinical target volume margins around the gross nodal tumor volume in head-and-neck cancer by assessing microscopic tumor extension beyond cervical lymph node capsules. Methods and Materials: Histologic sections of 96 dissected cervical lymph nodes with extracapsular extension (ECE) from 48 patients with head-and-neck squamous cell carcinoma were examined. The maximum linear distance from the external capsule border to the farthest extent of the tumor or tumoral reaction was measured. The trends of ECE as a function of the distance from the capsule and lymph node size were analyzed. Results: The median diameter of all lymph nodes was 11.0 mm (range: 3.0-30.0 mm). The mean and median ECE extent was 2.2 mm and 1.6 mm, respectively (range: 0.4-9.0 mm). The ECE was <5 mm from the capsule in 96% of the nodes. As the distance from the capsule increased, the probability of tumor extension declined. No significant difference between the extent of ECE and lymph node size was observed. Conclusion: For N1 nodes that are at high risk for ECE but not grossly infiltrating musculature, 1 cm clinical target volume margins around the nodal gross tumor volume are recommended to cover microscopic nodal extension in head-and-neck cancer.

Original languageEnglish (US)
Pages (from-to)678-683
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume64
Issue number3
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

Keywords

  • Clinical target volume
  • Extracapsular extension
  • Head and neck
  • Lymph node

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Apisarnthanarax, S., Elliott, D. D., El-Naggar, A. K., Asper, J. A., Blanco, A., Ang, K. K., Garden, A. S., Morrison, W. H., Rosenthal, D., Weber, R. S., & Chao, K. S. C. (2006). Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes. International Journal of Radiation Oncology Biology Physics, 64(3), 678-683. https://doi.org/10.1016/j.ijrobp.2005.08.020