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Volume 14, Number 2, 2009

Isolated nodal failure after chemo-radiotherapy in limited disease small cell lung cancer (LD-SCLC)



BACKGROUND: The irradiation volume for treatment of limited disease small cell lung cancer (LDSCLC), are still controversial. One of the aspects of radiation volume is the use of elective nodal irradiation (ENI), which has never been subjected to randomized study in SCLC patients.
AIM: To review retrospectively patterns of failure in relation to the radiation fi eld after chemoradiotherapy (CHT-RT) in patients with limited disease small cell lung cancer (LD-SCLC).
MATERIAL AND METHODS: Between 1997 and 2006, 117 consecutive patients with LD-SCLC received chemotherapy with sequential radiotherapy (70%) and concurrent or alternating CHT-RT (30%). All but one case had predefi ned elective nodal irradiation (ENI) without inclusion of supraclavicular regions. Prophylactic cranial irradiation (PCI) was administered to 39% of patients.
RESULTS: The median follow-up for the 20 living patients was 33 months. The overall survival at 2 years was 36% (median survival: 18 months). In-fi eld locoregional progression was observed in 42 patients (36%). Distant metastases occurred in 71 patients (61%). Five patients (4%) developed isolated nodal failure (INF) without local progression in the supraclavicular region. Patients with INF had N3 disease more often than those without INF (60% vs 21%, p = 0.04). There was 5% RTOG grade 3 or higher early radiation toxicity.
CONCLUSIONS: INF failures are rare; however, the need for extension of ENI to supraclavicular areas may be reconsidered in N3 patients.

Signature: Rep Pract Oncol Radiother, 2009; 14(2) : 58-63


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