title: Identification of risk factors and characteristics of supraclavicular lymph node metastasis in patients with small cell lung cancer.
abstract: Thoracic radiotherapy provides a survival benefit in patients with limited-stage disease of small cell lung cancer (LS-SCLC), but inclusion and exclusion of prophylactic irradiation of the supraclavicular area are still controversial. This study analyses the risk factors and characteristics of lymph node metastases in the supraclavicular area of LS-SCLC patients, which could help in developing a better radiotherapy for the patients. A total of 239 patients with LS-SCLC were included in this retrospective analysis. Clinical characteristics and mediastinal lymph node metastasis were analyzed for association with SCM, and the SCM pattern was further analyzed based on the treatment planning CT scans. The SCM incidence was 34.7 % (83 of 239). The multivariate analysis showed that only the mediastinal level 2 (OR = 16.101, P = 0.000) and level 3 (OR = 5.597, P = 0.000) lymph node metastases were significantly associated with SCM. As the most frequently involved region, supraclavicular level I lymph node metastases were identified in 61 of 83 patients (73.5 %), followed by level III, level IV, level V, and level II lymph node metastases, accounting a total of 95.2 % for level I and/or III lymph node metastases, whereas the incidence of skip metastasis was only 4.8 %. SCLC patients with mediastinal level 2 and level 3 lymph node metastasis were at high risk of SCM. If prophylactic irradiation therapy is considered, the nodal clinical target volume of irradiation should include bilateral lower para-recurrent laryngeal neural region (level I) and the para-internal jugular venous region (level III).
authors: Key Laboratory of Cancer Prevention and Therapy, Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.
authors: Zhen-Xing
authors: ZX
authors: Feng
authors: Lu-Jun
authors: LJ
authors: Zhao
authors: Yong
authors: Y
authors: Guan
authors: Yao
authors: Y
authors: Sun
authors: Mao-Bin
authors: MB
authors: Meng
authors: Kai
authors: K
authors: Ji
authors: Ping
authors: P
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000473:pathology*; D014057:Tomography, X-Ray Computed
references: Arch Otolaryngol Head Neck Surg. 1999 Apr;125(4):388-96
references: 10208676
references: Radiology. 1998 Aug;208(2):511-5
references: 9680584
references: Int J Radiat Oncol Biol Phys. 2010 Jun 1;77(2):329-36
references: 19782478
references: Oncologist. 2007 Sep;12(9):1096-104
references: 17914079
references: J Thorac Oncol. 2009 May;4(5):568-77
references: 19357537
references: Lung Cancer. 2002 Sep;37(3):271-6
references: 12234695
references: Radiother Oncol. 2006 Sep;80(3):307-12
references: 16949169
references: Cancer. 2012 Jan 1;118(1):278-87
references: 21598237
references: Pract Radiat Oncol. 2012 Oct-Dec;2(4):274-278
references: 24674164
references: Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1208-10
references: 22115553
references: Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1262-9
references: 16253781
references: J Clin Oncol. 2004 Aug 15;22(16):3248-54
references: 15310768
references: J Clin Oncol. 2006 Oct 1;24(28):4539-44
references: 17008692
references: Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1604-12
references: 16198509
references: Int J Radiat Oncol Biol Phys. 2008 Oct 1;72(2):327-34
references: 18793952
references: Radiology. 2004 Jul;232(1):75-80
references: 15166326