Positron emission tomography/computed tomography-guided intensity-modulated radiotherapy for limited-stage small-cell lung cancer

Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):e91-7. doi: 10.1016/j.ijrobp.2010.12.072. Epub 2011 Apr 12.


Purpose: Omitting elective nodal irradiation from planning target volumes does not compromise outcomes in patients with non-small-cell lung cancer, but whether the same is true for those with limited-stage small-cell lung cancer (LS-SCLC) is unknown. Therefore, in the present study, we sought to determine the clinical outcomes and the frequency of elective nodal failure in patients with LS-SCLC staged using positron emission tomography/computed tomography and treated with involved-field intensity-modulated radiotherapy.

Methods and materials: Between 2005 and 2008, 60 patients with LS-SCLC at our institution underwent disease staging using positron emission tomography/computed tomography before treatment using an intensity-modulated radiotherapy plan in which elective nodal irradiation was intentionally omitted from the planning target volume (mode and median dose, 45 Gy in 30 fractions; range, 40.5 Gy in 27 fractions to 63.8 Gy in 35 fractions). In most cases, concurrent platinum-based chemotherapy was administered. We retrospectively reviewed the clinical outcomes to determine the overall survival, relapse-free survival, and failure patterns. Elective nodal failure was defined as recurrence in initially uninvolved hilar, mediastinal, or supraclavicular nodes. Survival was assessed using the Kaplan-Meier method.

Results: The median age of the study patients at diagnosis was 63 years (range, 39-86). The median follow-up duration was 21 months (range, 4-58) in all patients and 26 months (range, 4-58) in the survivors. The 2-year actuarial overall survival and relapse-free survival rate were 58% and 43%, respectively. Of the 30 patients with recurrence, 23 had metastatic disease and 7 had locoregional failure. We observed only one isolated elective nodal failure.

Conclusions: To our knowledge, this is the first study to examine the outcomes in patients with LS-SCLC staged with positron emission tomography/computed tomography and treated with definitive intensity-modulated radiotherapy. In these patients, elective nodal irradiation can be safely omitted from the planning target volume for the purposes of dose escalation and toxicity reduction.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Dose Fractionation, Radiation
  • Esophagitis / etiology
  • Female
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Lymphatic Irradiation
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Multimodal Imaging / methods*
  • Neoplasm Recurrence, Local
  • Neoplasm Staging / methods
  • Neutropenia / etiology
  • Positron-Emission Tomography*
  • Radiation Pneumonitis / etiology
  • Radiotherapy, Intensity-Modulated / adverse effects
  • Radiotherapy, Intensity-Modulated / methods*
  • Retrospective Studies
  • Small Cell Lung Carcinoma / diagnostic imaging*
  • Small Cell Lung Carcinoma / drug therapy
  • Small Cell Lung Carcinoma / pathology
  • Small Cell Lung Carcinoma / radiotherapy*
  • Survival Analysis
  • Tomography, X-Ray Computed*
  • Treatment Outcome