title: Patterns of local-regional failure in completely resected stage IIIA(N2) non-small cell lung cancer cases: implications for postoperative radiation therapy clinical target volume design.
abstract: OBJECTIVE
  To analyze patterns of local-regional failure (LRF) for completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) patients treated in our hospital and to propose a clinical target volume (CTV) for postoperative radiation therapy (PORT) in these patients.
  
  
  METHODS
  From 2005 to 2011, consecutive patients with pT1-3N2 NSCLC who underwent complete resection in our hospital but who did not receive PORT were identified. The patterns of first LRF were assessed and evaluated as to whether these areas would be encompassed by our proposed PORT CTV.
  
  
  RESULTS
  With a median follow-up of 24 months, 173 of 250 patients (69.2%) experienced disease recurrence. Of the 54 patients with LRF as the first event, 48 (89%) had recurrence within the proposed PORT CTV, and 6 (11%) had failures occurring both within and outside the proposed CTV (all of which occurred in patients with right-lung cancer). Ninety-three percent of failure sites (104 of 112) would have been contained within the proposed PORT CTV. For left-sided lung cancer, the most common lymph node station failure site was 4R, followed by 7, 4L, 6, 10L, and 5. For right-sided lung cancer, the most common site was station 2R, followed by 10R, 4R, and 7.
  
  
  CONCLUSIONS
  LRF following complete surgery was an important and potentially preventable pattern of failure in stage IIIA(N2) patients. Ipsilateral superior mediastinal recurrences dominated for right-sided tumors, whereas left-sided tumors frequently involved the bilateral superior mediastinum. Most of the LRF sites would have been covered by the proposed PORT CTV. A prospective investigation of patterns of failure after PORT (following our proposed CTV delineation guideline) is presently underway and will be reported in a separate analysis.
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Wen
authors: W
authors: Feng
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Electronic address: xlfu1964@hotmail.com.
authors: Xiao-Long
authors: XL
authors: Fu
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Xu-Wei
authors: XW
authors: Cai
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Huan-Jun
authors: HJ
authors: Yang
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Kai-Liang
authors: KL
authors: Wu
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Min
authors: M
authors: Fan
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Jia-Qing
authors: JQ
authors: Xiang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Ya-Wei
authors: YW
authors: Zhang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Hai-Quan
authors: HQ
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000528:radiation effects; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy; D011829:Radiation Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome