title: PET-CT use and the occurrence of elective nodal failure in involved field radiotherapy for non-small cell lung cancer: A systematic review.
abstract: OBJECTIVE
  Current guidelines do not recommend the use of elective nodal irradiation for NSCLC, for several reasons. One of these is that PET-CT provides adequate nodal staging. We compared the published rates of elective nodal failures (ENFs) defined as regional failures that occur without local recurrence irrespectively of distant metastases status in patients who did or did not undergo PET-CT for staging.
  
  
  METHODS
  Reports of the occurrence of ENFs were considered. Only studies that used involved fields and specified the number of ENFs in patients with and without PET-CT use were included. A chi-squared test was used for the comparison of the risk of ENF in patients staged with and without PET.
  
  
  RESULTS
  Forty-eight studies were included; 2158 and 1487 patients with and without PET-CT performed before radiotherapy were identified. The proportion of patients treated with SBRT was higher in the group with PET-CT (71%) than it was in the group without PET-CT (20%; p<.001). There were 136 (6.3%) and 98 (6.6%) ENFs in patients with and without PET-CT, respectively (p=.74).
  
  
  CONCLUSIONS
  The failure to reduce ENF by PET-CT was demonstrated. These data should be regarded in the context of the adequacy of reporting the rate of ENF and recognized value of PET-CT in NSCLC treatment.
authors.affiliation: Radiation Oncology Department, Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Centre, Olsztyn, Poland. Electronic address: lucynak@coi.pl.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Kepka
authors.affiliation: Radiation Oncology Department, Regional Oncology Centre, Czestochowa, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Socha
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
keywords: Elective nodal failure; Involved-field radiotherapy; Non-small cell lung cancer; PET-CT