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@ARTICLE{Rimner:299584,
      author       = {A. Rimner and C. S. Dejonckheere and J. Sahlmann and S. A.
                      Barth and T. Schimek-Jasch and S. Adebahr$^*$ and M. Hecht
                      and C. F. Waller and S. Schmid and D. Stolz and M. Miederer
                      and A. Brose and H. Binder and J. König and A.-L. Grosu and
                      U. Nestle and E. Gkika},
      title        = {{I}mpact of {D}ifferent {M}ediastinal {S}taging
                      {M}odalities on {T}arget {V}olume {D}elineation in {L}ocally
                      {A}dvanced {N}on-{S}mall-{C}ell {L}ung {C}ancer: {A}
                      {S}econdary {A}nalysis of the {M}ulticenter {R}andomized
                      {PET}-{P}lan {T}rial.},
      journal      = {International journal of radiation oncology, biology,
                      physics},
      volume       = {122},
      number       = {5},
      issn         = {0360-3016},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2025-00525},
      pages        = {1217-1226},
      year         = {2025},
      note         = {Volume 122, Issue 5, 1 August 2025, Pages 1217-1226},
      abstract     = {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 with
                      definitive chemoradiotherapy in the prospective XXX trial
                      (XXX; NCTXXX) and to evaluate the impact of endobronchial
                      ultrasound-guided transbronchial needle aspiration
                      (EBUS-TBNA) and mediastinoscopy on target volume
                      definition.Patients treated per-protocol (n = 172), all
                      receiving isotoxically dose-escalated chemoradiotherapy,
                      were included in this unplanned secondary analysis.
                      Radiation treatment planning was based on an 18F-FDG PET/CT
                      targeting all CT positive lymph nodes (i.e. short axis
                      diameter > 10 mm), even if PET-negative, plus elective nodal
                      irradiation (arm A) or targeting only PET-positive nodes
                      (arm B). The concordance rate between different staging
                      modalities and their impact on target volume delineation
                      were calculated.The median follow-up time $(95\%$ confidence
                      interval) was 41.1 (33.8-50.4) months. A total of 2,752
                      lymph node stations were evaluated non-invasively, 330 were
                      examined invasively. Of 172 patients, 87 $(50.6\%)$
                      underwent at least one invasive staging modality. The number
                      of different staging procedures per patient did not
                      correlate with any of the primary endpoints (OS, PFS, or
                      FFLP). The sensitivity of 18F-FDG PET/CT was $89.7\%$
                      (78/87) and the specificity $67.5\%$ (112/166) based on
                      histology as assessed by EBUS. When using the results from
                      mediastinoscopy, the sensitivity of PET was $82.6\%$ (19/23)
                      and the specificity $66.7\%$ (36/54). Based on invasive
                      staging methods, 13 lymph node stations in 9 patients
                      $(10.3\%)$ were PET-negative while positive on invasive
                      staging, thus leading to a significant adjustment of the
                      target volume.In this unplanned secondary analysis of the
                      XXX trial, the additional use of invasive staging resulted
                      in relevant changes of the target volume in a tenth of
                      patients. Invasive staging did not, however, have an effect
                      on outcome in this trial, with a low rate of isolated
                      out-of-field recurrences (6 in arm A versus 3 in arm B).
                      Radiation treatment planning can thus be based on invasive
                      staging in addition to non-invasive PET in patients
                      undergoing definitive chemoradiotherapy for locally advanced
                      NSCLC. Prospective randomized data are required to confirm
                      these findings.},
      keywords     = {(18)F-FDG PET/CT (Other) / definitive chemoradiotherapy
                      (Other) / endobronchial ultrasound (Other) / mediastinoscopy
                      (Other) / non-small-cell lung cancer (Other) / staging
                      (Other)},
      cin          = {FR01},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40054586},
      doi          = {10.1016/j.ijrobp.2025.02.041},
      url          = {https://inrepo02.dkfz.de/record/299584},
}