Incidence of isolated nodal failure in non-small cell lung cancer patients included in a prospective study of the value of PET-CT.
OBJECTIVE
Elective nodal irradiation (ENI) is not recommended in PET-CT-based radiotherapy for NSCLC despite a low level of evidence to support such guidelines. The aim of this investigation is to find out whether omitting ENI is safe.


METHODS
Sixty-seven patients treated within a frame of a previously published prospective trial of the value of PET-CT were included in the analysis. Seventeen (25%) patients received ENI due to higher initial nodal involvement and in the remaining 50 patients (75%) with N0-N1 or single N2 disease ENI was omitted. Isolated nodal failure (INF) was recorded if relapse occurred in the initially uninvolved regional lymph node without previous or simultaneous local recurrence regardless of the status of distant metastases.


RESULTS
With a median follow-up of 32 months, the estimated 3-year overall survival was 42%, local progression-free interval was 55%, and distant metastases-free interval was 62%. Three patients developed INF; all had ENI omitted from treatment, giving a final result of three INFs in 50 (6%) patients treated without ENI. In this group of patients, the 3-year cause-specific cumulative incidence of INF was 6.4% (95% confidence interval: 0-17%).


CONCLUSIONS
The omission of ENI appears to be not as safe as suggested by current recommendations.
Department of Radiation Oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Milena
M
Kolodziejczyk
Krzysztof
K
Bujko
Wojciech
W
Michalski
Lucyna
L
Kepka
D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000528:radiation effects*; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed