title: Total gross tumor volume is an independent prognostic factor in patients treated with selective nodal irradiation for stage I to III small cell lung cancer.
abstract: OBJECTIVE
  In non-small cell lung cancer, gross tumor volume (GTV) influences survival more than other risk factors. This could also apply to small cell lung cancer.
  
  
  METHODS
  Analysis of our prospective database with stage I to III SCLC patients referred for concurrent chemo radiation therapy. Standard treatment was 45 Gy in 1.5-Gy fractions twice daily concurrently with carboplatin-etoposide, followed by prophylactic cranial irradiation (PCI) in case of non-progression. Only fluorodeoxyglucose (FDG)-positron emission tomography (PET)-positive or pathologically proven nodal sites were included in the target volume. Total GTV consisted of post chemotherapy tumor volume and pre chemotherapy nodal volume. Survival was calculated from diagnosis (Kaplan-Meier ).
  
  
  RESULTS
  A total of 119 patients were included between May 2004 and June 2009. Median total GTV was 93 ± 152 cc (7.5-895 cc). Isolated elective nodal failure occurred in 2 patients (1.7%). Median follow-up was 38 months, median overall survival 20 months (95% confidence interval = 17.8-22.1 months), and 2-year survival 38.4%. In multivariate analysis, only total GTV (P=.026) and performance status (P=.016) significantly influenced survival.
  
  
  CONCLUSIONS
  In this series of stage I to III small cell lung cancer patients treated with FDG-PET-based selective nodal irradiation total GTV is an independent risk factor for survival.
authors.affiliation: Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands. bart.reymen@maastro.nl
authors.forename: Bart
authors.initials: B
authors.lastname: Reymen
authors.forename: Judith
authors.initials: J
authors.lastname: Van Loon
authors.forename: Angela
authors.initials: A
authors.lastname: van Baardwijk
authors.forename: Rinus
authors.initials: R
authors.lastname: Wanders
authors.forename: Jacques
authors.initials: J
authors.lastname: Borger
authors.forename: Anne-Marie C
authors.initials: AM
authors.lastname: Dingemans
authors.forename: Gerben
authors.initials: G
authors.lastname: Bootsma
authors.forename: Cordula
authors.initials: C
authors.lastname: Pitz
authors.forename: Ragnar
authors.initials: R
authors.lastname: Lunde
authors.forename: Wiel
authors.initials: W
authors.lastname: Geraedts
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D016371:Cranial Irradiation; D018450:Disease Progression; D004941:Esophagitis / Q000209:etiology; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D015182:Lymphatic Irradiation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011877:Radionuclide Imaging; D011879:Radiotherapy Dosage; D012720:Severity of Illness Index; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D016190:Carboplatin