title: Analysis of the influence of elective nodal irradiation on postirradiation pulmonary function.
abstract: Irradiation (RT) field selection for bronchogenic carcinoma is based on such factors as extent of disease, pulmonary function, and the perceived need for elective nodal irradiation (ENI). A technique of superimposing a patient's RT treatment film onto his quantitative perfusion lung scan can predict the fractional volume of perfused lung receiving RT and has been shown to reliably estimate the minimum post-RT pulmonary function as measured by the forced expiratory volume in one second (FEV1). This technique has been applied to 20 patients with nonresected clinically staged T1-4N0M0 lesions to quantify the pulmonary impact of varying degrees of ENI. The five treatment volumes selected were as follows: (1) tumor volume plus a 2-cm margin; (2) volume 1 plus ipsilateral hilum; (3) volume 2 plus mediastinum; (4) volume 3 plus supraclavicular fossae; and (5) volume 4 plus contralateral hilum. The median pre-RT FEV1 was 2.0 l, and the median predicted minimal post-RT FEV1 for each proposed field was field 1, 1.7 l; field 2, 1.5 l; field 3, 1.3 l; field 4, 1.1.; and field 5, 1.0 l. The decline in median predicted FEV1 with each increase in field size ranged from 2% to 12%, with a broad range of declines for each field. Such quantification can aid in decisions regarding ENI for patients with impaired pulmonary function.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111.
authors.forename: W J
authors.initials: WJ
authors.lastname: Curran
authors.forename: P J
authors.initials: PJ
authors.lastname: Moldofsky
authors.forename: L J
authors.initials: LJ
authors.lastname: Solin
mesh_terms: D002283:Carcinoma, Bronchogenic / Q000503:physiopathology / Q000532:radiotherapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000528:radiation effects*; D011879:Radiotherapy Dosage