Selective nodal irradiation on basis of (18)FDG-PET scans in limited-disease small-cell lung cancer: a prospective study.
OBJECTIVE
To evaluate the results of selective nodal irradiation on basis of (18)F-deoxyglucose positron emission tomography (PET) scans in patients with limited-disease small-cell lung cancer (LD-SCLC) on isolated nodal failure.


METHODS
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 (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.


CONCLUSIONS
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.
Department of Radiation Oncology, Maastro Clinic, GROW Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands. Judith.vanloon@maastro.nl
Judith
J
van Loon
Dirk
D
De Ruysscher
Rinus
R
Wanders
Liesbeth
L
Boersma
Jean
J
Simons
Michel
M
Oellers
Anne-Marie C
AM
Dingemans
Monique
M
Hochstenbag
Gerben
G
Bootsma
Wiel
W
Geraedts
Cordula
C
Pitz
Jaap
J
Teule
Ali
A
Rhami
Willy
W
Thimister
Gabriel
G
Snoep
Cary
C
Dehing-Oberije
Philippe
P
Lambin
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy*; D015182:Lymphatic Irradiation / Q000379:methods*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005047:Etoposide; D016190:Carboplatin