Department of Radiation Oncology, Maastro Clinic, GROW Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands.
Int J Radiat Oncol Biol Phys. 2010 Jun 1;77(2):329-36. doi: 10.1016/j.ijrobp.2009.04.075. Epub 2009 Sep 24.
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.
评估基于（18）F-脱氧葡萄糖正电子发射断层扫描（PET）的选择性淋巴结照射在孤立性淋巴结失败的局限性小细胞肺癌（LD-SCLC）患者中的结果。
对 60 例 LD-SCLC 患者进行了前瞻性研究。放疗剂量为 45 Gy，每日两次，每次 1.5 Gy，同时给予卡铂和依托泊苷化疗。仅照射预处理 PET 扫描中原发肿瘤和受累纵隔淋巴结。放疗结束后 3 个月和此后每 6 个月进行一次胸部 CT 扫描。
30%的患者（95%置信区间，20-43%）在预处理（18）F-脱氧葡萄糖 PET 扫描和 CT 扫描中受累淋巴结站之间存在差异。60 例患者中，39 例（65%；95%置信区间 [CI]，52-76%）出现复发；2 例（3%，95%CI，1-11%）出现孤立性区域失败。中位累积总生存率为 19 个月（95%CI，17-21）。中位累积无进展生存率为 14 个月（95%CI，12-16）。12%（95%CI，6-22%）的患者出现 3 级急性（不良事件通用术语标准，版本 3.0）食管炎。
基于 PET 的 LD-SCLC 选择性淋巴结照射导致孤立性淋巴结失败率较低（3%），急性食管炎发生率较低。这些发现与我们基于 CT 的选择性淋巴结照射前瞻性研究的结果形成对比，后者导致孤立性淋巴结失败的比例出乎意料地高（11%）。由于孤立性淋巴结失败和毒性发生率较低，我们认为我们的数据支持使用基于 PET 的 SNI 治疗 LD-SCLC。
