title: Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, Hôpital Tenon, Paris, France. philippe.giraud@curie.net
authors.forename: P
authors.initials: P
authors.lastname: Giraud
authors.forename: M
authors.initials: M
authors.lastname: Antoine
authors.forename: A
authors.initials: A
authors.lastname: Larrouy
authors.forename: B
authors.initials: B
authors.lastname: Milleron
authors.forename: P
authors.initials: P
authors.lastname: Callard
authors.forename: Y
authors.initials: Y
authors.lastname: De Rycke
authors.forename: M F
authors.initials: MF
authors.lastname: Carette
authors.forename: J C
authors.initials: JC
authors.lastname: Rosenwald
authors.forename: J M
authors.initials: JM
authors.lastname: Cosset
authors.forename: M
authors.initials: M
authors.lastname: Housset
authors.forename: E
authors.initials: E
authors.lastname: Touboul
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results