Selective Nodal Irradiation on Basis of {sup 18}FDG-PET Scans in Limited-Disease Small-Cell Lung Cancer: A Prospective Study
- Department of Radiation Oncology, Maastro Clinic, GROW Research Institute, Maastricht University Medical Centre, Maastricht (Netherlands)
- Department of Pulmonology, St. Jans Hospital, Weert (Netherlands)
- Department of Pulmonology, University Medical Centre, Maastricht (Netherlands)
- Department of Pulmonology, Atrium Medical Centre, Heerlen (Netherlands)
- Department of Pulmonology, Orbis Medical Centre, Sittard (Netherlands)
- Department of Pulmonology, Laurentius Hospital, Roermond (Netherlands)
- Department of Nuclear Medicine, University Medical Centre, Maastricht (Netherlands)
- Department of Nuclear Medicine, Atrium Medical Centre, Heerlen (Netherlands)
- Department of Nuclear Medicine, Orbis Medical Centre, Sittard (Netherlands)
- Department of Radiology, University Medical Centre, Maastricht (Netherlands)
Purpose: To evaluate the results of selective nodal irradiation on basis of {sup 18}F-deoxyglucose positron emission tomography (PET) scans in patients with limited-disease small-cell lung cancer (LD-SCLC) on isolated nodal failure. Methods and Materials: A prospective study was performed of 60 patients with LD-SCLC. Radiotherapy was given to a dose of 45 Gy in twice-daily fractions of 1.5 Gy, concurrent with carboplatin and etoposide chemotherapy. Only the primary tumor and the mediastinal lymph nodes involved on the pretreatment PET scan were irradiated. A chest computed tomography (CT) scan was performed 3 months after radiotherapy completion and every 6 months thereafter. Results: A difference was seen in the involved nodal stations between the pretreatment {sup 18}F-deoxyglucose PET scans and computed tomography scans in 30% of patients (95% confidence interval, 20-43%). Of the 60 patients, 39 (65%; 95% confidence interval [CI], 52-76%) developed a recurrence; 2 patients (3%, 95% CI, 1-11%) experienced isolated regional failure. The median actuarial overall survival was 19 months (95% CI, 17-21). The median actuarial progression-free survival was 14 months (95% CI, 12-16). 12% (95% CI, 6-22%) of patients experienced acute Grade 3 (Common Terminology Criteria for Adverse Events, version 3.0) esophagitis. Conclusion: PET-based selective nodal irradiation for LD-SCLC resulted in a low rate of isolated nodal failures (3%), with a low percentage of acute esophagitis. These findings are in contrast to those from our prospective study of CT-based selective nodal irradiation, which resulted in an unexpectedly high percentage of isolated nodal failures (11%). Because of the low rate of isolated nodal failures and toxicity, we believe that our data support the use of PET-based SNI for LD-SCLC.
- OSTI ID:
- 21372276
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 77, Issue 2; Other Information: DOI: 10.1016/j.ijrobp.2009.04.075; PII: S0360-3016(09)00673-7; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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