Selective Nodal Irradiation on Basis of 18FDG-PET Scans in Limited-Disease Small-Cell Lung Cancer: A Prospective Study

医学 不良事件通用术语标准 放射治疗 前瞻性队列研究 核医学 置信区间 食管炎 肺癌 正电子发射断层摄影术 卡铂 放射科 节的 危险系数 内科学 化疗 疾病 顺铂 回流
作者
Judith van Loon,Dirk De Ruysscher,Rinus Wanders,Liesbeth Boersma,Jean Simons,M. Oellers,Anne‐Marie C. Dingemans,Monique Hochstenbag,Gerben Bootsma,Wiel Geraedts,Cordula Pitz,Jaap Teule,Ali Rhami,Willy Thimister,Gabriël Snoep,Cary Oberije,Philippe Lambin
出处
期刊:International Journal of Radiation Oncology Biology Physics [Elsevier BV]
卷期号:77 (2): 329-336 被引量:177
标识
DOI:10.1016/j.ijrobp.2009.04.075
摘要

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.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.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.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.
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