Impact of Different Mediastinal Staging Modalities on Target Volume Delineation in Locally Advanced Non-Small Cell Lung Cancer: A Secondary Analysis of the Multicenter Randomized PET-Plan Trial

• DOI: 10.1016/j.ijrobp.2025.02.041
• Publication Date: 2025-03-06T00:15:22Z
• Authors: Andreas Rimner; Cas Stefaan Dejon...; Jörg Sahlmann; Simeon Ari Barth; Tanja Schimek-Jasch; Sonja Adebahr; Markus Hecht; Cornelius F. Waller; Severin Schmid; Daiana Stolz; Matthias Miederer; Alexander Brose; Harald Binder; Jochem König; Anca-Ligia Grosu; Ursula Nestle; Eleni Gkika
• Keywords: Concordance; Chemoradiotherapy; Mediastinal lymph node; Pathological staging

To evaluate the role of different invasive and non-invasive mediastinal staging methods in patients with locally advanced non-small-cell lung cancer (NSCLC) treated definitive chemoradiotherapy prospective XXX trial (XXX; NCTXXX) to impact endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) mediastinoscopy on target volume definition. Patients per-protocol (n = 172), all receiving isotoxically dose-escalated chemoradiotherapy, were included this unplanned secondary analysis. Radiation treatment planning was based an 18F-FDG PET/CT targeting CT positive lymph nodes (i.e. short axis diameter > 10 mm), even if PET-negative, plus elective nodal irradiation (arm A) or only PET-positive B). The concordance rate between modalities their delineation calculated. median follow-up time (95% confidence interval) 41.1 (33.8-50.4) months. A total 2,752 node stations evaluated non-invasively, 330 examined invasively. Of 172 patients, 87 (50.6%) underwent at least one modality. number procedures per patient did not correlate any primary endpoints (OS, PFS, FFLP). sensitivity 89.7% (78/87) specificity 67.5% (112/166) histology as assessed by EBUS. When using results from mediastinoscopy, PET 82.6% (19/23) 66.7% (36/54). Based methods, 13 9 (10.3%) PET-negative while staging, thus leading a significant adjustment volume. In analysis trial, additional use resulted relevant changes tenth patients. Invasive not, however, have effect outcome low isolated out-of-field recurrences (6 arm versus 3 can be addition undergoing for NSCLC. Prospective randomized data are required confirm these findings.