Selective nodal irradiation on basis of (18)FDG-PET scans in limited-disease small-cell lung cancer: a prospective study

Judith van Loon, Dirk De Ruysscher, Rinus Wanders, Liesbeth Boersma, Jean P. Simons, Michel Oellers, Anne-Marie C Dingemans, Monique Hochstenbag, Gerben Bootsma, Wiel Geraedts, Cordula Pitz, Jaap Teule, Ali Rhami, Willy Thimister, Gabriel Snoep, Cary Dehing-Oberije, Philippe Lambin

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE: To evaluate the results of selective nodal irradiation on basis of (18)F-deoxyglucose positron emission tomography (PET) scans in patients with limited-disease small-cell lung cancer (LD-SCLC) on isolated nodal failure.

METHODS AND MATERIALS: A prospective study was performed of 60 patients with LD-SCLC. Radiotherapy was given to a dose of 45 Gy in twice-daily fractions of 1.5 Gy, concurrent with carboplatin and etoposide chemotherapy. Only the primary tumor and the mediastinal lymph nodes involved on the pretreatment PET scan were irradiated. A chest computed tomography (CT) scan was performed 3 months after radiotherapy completion and every 6 months thereafter.

RESULTS: A difference was seen in the involved nodal stations between the pretreatment (18)F-deoxyglucose PET scans and computed tomography scans in 30% of patients (95% confidence interval, 20-43%). Of the 60 patients, 39 (65%; 95% confidence interval [CI], 52-76%) developed a recurrence; 2 patients (3%, 95% CI, 1-11%) experienced isolated regional failure. The median actuarial overall survival was 19 months (95% CI, 17-21). The median actuarial progression-free survival was 14 months (95% CI, 12-16). 12% (95% CI, 6-22%) of patients experienced acute Grade 3 (Common Terminology Criteria for Adverse Events, version 3.0) esophagitis.

CONCLUSION: PET-based selective nodal irradiation for LD-SCLC resulted in a low rate of isolated nodal failures (3%), with a low percentage of acute esophagitis. These findings are in contrast to those from our prospective study of CT-based selective nodal irradiation, which resulted in an unexpectedly high percentage of isolated nodal failures (11%). Because of the low rate of isolated nodal failures and toxicity, we believe that our data support the use of PET-based SNI for LD-SCLC.

Original languageEnglish
Pages (from-to)329-36
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume77
Issue number2
DOIs
Publication statusPublished - 1 Jun 2010

Keywords

  • Antineoplastic Combined Chemotherapy Protocols
  • Carboplatin
  • Combined Modality Therapy
  • Etoposide
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms
  • Lymphatic Irradiation
  • Male
  • Mediastinum
  • Middle Aged
  • Positron-Emission Tomography
  • Prospective Studies
  • Radiopharmaceuticals
  • Radiotherapy Dosage
  • Radiotherapy, Conformal
  • Small Cell Lung Carcinoma
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Journal Article

Cite this

van Loon, J., De Ruysscher, D., Wanders, R., Boersma, L., Simons, J. P., Oellers, M., Dingemans, A-M. C., Hochstenbag, M., Bootsma, G., Geraedts, W., Pitz, C., Teule, J., Rhami, A., Thimister, W., Snoep, G., Dehing-Oberije, C., & Lambin, P. (2010). Selective nodal irradiation on basis of (18)FDG-PET scans in limited-disease small-cell lung cancer: a prospective study. International Journal of Radiation Oncology Biology Physics, 77(2), 329-36. https://doi.org/10.1016/j.ijrobp.2009.04.075