title: A new approach to delineating lymph node target volumes for post-operative radiotherapy in gastric cancer: A phase II trial.
abstract: OBJECTIVE
  In the context of gastric cancer, lymph node target volume delineation for post-operative radiotherapy is currently built on the traditional system of dividing the stomach and 2-D treatment methods. Here, we have proposed a new delineation approach with irradiation indications for lymph node stations. Its safety and efficacy were evaluated in a phase II clinical trial.
  
  
  METHODS
  Fifty-four gastric cancer patients with D2 lymph node dissection received 2 cycles of FOLFOX4. They subsequently received concurrent chemoradiotherapy (45 Gy at 1.8 Gy per fraction, 5 fractions per week for 5 weeks) with a 5-fluorouracil/leucovorin regimen, followed by 4 additional FOLFOX4 cycles. The target volume included the remnant stomach, anastomosis site, tumor bed, and regional lymph nodes selected through our new approach by taking gastric arteries as references.
  
  
  RESULTS
  The most common grade 3-4 adverse event was neutropenia (14.8%). Neutropenia, anemia, and nausea were common grade 1-2 toxicities. No treatment-related deaths occurred during treatment. The 3-year overall, disease-free, and locoregional recurrence-free survival rates were 81.6%, 70.2%, and 91.1%, respectively. Eight patients developed peritoneal or distant metastases.
  
  
  CONCLUSIONS
  Using our new approach and irradiation indications, delineation of the target volume of post-operative lymph node stations was feasible and well tolerated after D2 resection in patients with gastric cancer.
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Haijun
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Wu
authors.initials: W
authors.lastname: Qiuji
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Fu
authors.initials: F
authors.lastname: Zhenming
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Huang
authors.initials: H
authors.lastname: Yong
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Liao
authors.initials: L
authors.lastname: Zhengkai
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Xie
authors.initials: X
authors.lastname: Conghua
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Yunfeng
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China. Electronic address: doctorzyh1973@163.com.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Yahua
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D013274:Stomach Neoplasms / Q000532:radiotherapy* / Q000601:surgery
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil
keywords: D2 resection; Gastric arteries; Gastric cancer; Lymph node target volume delineation; Post-operative radiotherapy