title: Omission of elective node irradiation on basis of CT-scans in patients with limited disease small cell lung cancer: a phase II trial.
abstract: OBJECTIVE
  To evaluate the patterns of recurrence when elective node irradiation was omitted in patients with limited disease small cell lung cancer (LD-SCLC).
  
  
  METHODS
  A prospective phase II study was undertaken in 27 patients with LD-SCLC without detectable distant metastases on CT scan. Chest radiotherapy to a dose of 45 Gy in 30 fractions in 3 weeks (1.5 Gy BID with 6 - 8 h interval) was delivered concurrently with carboplatin and etoposide chemotherapy. Chest radiation started after a mean time of 17.7 days +/- 9.7 days (SD) (range: 0-33 days) after the beginning of chemotherapy. Only the primary tumour and the positive nodal areas on the pre-treatment CT scan were irradiated. A total of five chemotherapy cycles were administered, followed by prophylactic cranial irradiation (PCI) in patients without disease progression. Isolated nodal failure was defined as recurrence in the regional nodes outside of the clinical target volume, in the absence of in-field failure.
  
  
  RESULTS
  After a median time of 18 months post-radiotherapy, 7 patients (26%, 95% CI 19.5-42.5%) developed a local recurrence. Three patients (crude rate 11%, 95% CI 2.4-29%), developed an isolated nodal failure, all of them in the ipsilateral supraclavicular fossa. The median actuarial overall survival was 21 months (95% CI 15.3-26.7), and the median actuarial progression free survival was 16 months (95% CI 6.5-25.5). Eight patients developed an acute, reversible grade 3 (CTC 3.0) radiation oesophagitis (30%, 95% CI 14-50%).
  
  
  CONCLUSIONS
  Because of the small sample size, no definitive conclusions can be drawn. However, the omission of elective nodal irradiation on the basis of CT scans in patients with LD-SCLC resulted in a higher than expected rate of isolated nodal failures in the ipsilateral supraclavicular fossa. The incidence of acute, reversible oesophagitis was in the same range as reported with elective nodal fields. The safety of selective nodal irradiation in NSCLC should not be extrapolated to patients with LD-SCLC until more data are available. In the mean time, elective nodal irradiation should only be omitted in clinical trials.
authors.affiliation: MAASTRO Clinic, Maastricht, The Netherlands. dirk.deruysscher@maastro.nl
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
authors.forename: Robert-Harm
authors.initials: RH
authors.lastname: Bremer
authors.forename: Friederike
authors.initials: F
authors.lastname: Koppe
authors.forename: Stofferinus
authors.initials: S
authors.lastname: Wanders
authors.forename: Erik
authors.initials: E
authors.lastname: van Haren
authors.forename: Monique
authors.initials: M
authors.lastname: Hochstenbag
authors.forename: Wiel
authors.initials: W
authors.lastname: Geeraedts
authors.forename: Cordula
authors.initials: C
authors.lastname: Pitz
authors.forename: Jean
authors.initials: J
authors.lastname: Simons
authors.forename: Guul
authors.initials: G
authors.lastname: ten Velde
authors.forename: Jo
authors.initials: J
authors.lastname: Dohmen
authors.forename: Gabriel
authors.initials: G
authors.lastname: Snoep
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Boersma
authors.forename: Tom
authors.initials: T
authors.lastname: Verschueren
authors.forename: Angela
authors.initials: A
authors.lastname: van Baardwijk
authors.forename: Cary
authors.initials: C
authors.lastname: Dehing
authors.forename: Madelon
authors.initials: M
authors.lastname: Pijls
authors.forename: Andre
authors.initials: A
authors.lastname: Minken
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy*; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D017564:Radiation Pneumonitis / Q000209:etiology; D014057:Tomography, X-Ray Computed