Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Lung Cancer. 2012 Apr;76(1):72-7. doi: 10.1016/j.lungcan.2011.09.015. Epub 2011 Oct 19.
Omitting elective nodal irradiation (ENI) in limited-stage disease small cell lung cancer (LD-SCLC) is expected to result in smaller radiation fields. We report on data from a randomised phase II trial that omitted ENI in patients receiving concurrent chemo-radiotherapy for LD-SCLC. 38 patients with LD-SCLC were randomised to receive once-daily (66 Gy in 33 fractions) or twice-daily (45 Gy in 30 fractions) radiotherapy (RT). 3D-conformal RT was given concurrently with cisplatin and etoposide starting with the second cycle of a total of four cycles. The gross tumour volume was defined as primary tumour with involved lymph nodes (nodes ≥1 cm in short axis) identifiable with CT imaging. ENI was not used. Six recurrence patterns were identified: recurrence within planning target volume (PTV) only, recurrence within PTV+regional nodal recurrence and/or distant recurrence, isolated nodal recurrence outside PTV, nodal recurrence outside PTV+distant recurrence, distant metastases only and no recurrence. At median follow-up 16.9 months, 31/38 patients were evaluable and 14/31 patients had relapsed. There were no isolated nodal recurrences. Eight patients relapsed with intra-thoracic disease: 2 within PTV only, 4 within PTV and distantly and 2 with nodal recurrence outside PTV plus distant metastases. Rates of grade 3+ acute oesophagitis and pneumonitis in the 31 evaluable patients were 23 and 3% respectively. In our study of LD-SCLC, omitting ENI based on CT imaging was not associated with a high risk of isolated nodal recurrence, although further prospective studies are needed to confirm this. Routine ENI omission will be further evaluated prospectively in the ongoing phase III CONVERT trial (NCT00433563).
局限期小细胞肺癌（LD-SCLC）中省略选择性淋巴结照射（ENI）预计会导致照射野更小。我们报告了一项随机 2 期试验的数据，该试验在接受 LD-SCLC 同步放化疗的患者中省略了 ENI。38 例 LD-SCLC 患者被随机分为接受每日一次（66Gy/33 次）或每日两次（45Gy/30 次）放疗（RT）。3D 适形 RT 与顺铂和依托泊苷同时进行，共 4 个周期，每个周期进行 2 个周期。大体肿瘤体积定义为可通过 CT 成像识别的原发性肿瘤和受累淋巴结（短轴≥1cm 的淋巴结）。未使用 ENI。确定了 6 种复发模式：仅在计划靶区（PTV）内复发、PTV 内+区域淋巴结复发和/或远处复发、PTV 外孤立淋巴结复发、PTV 外淋巴结复发和远处复发、远处转移仅和无复发。中位随访 16.9 个月时，38 例患者中有 31 例可评估，31 例中有 14 例复发。没有孤立性淋巴结复发。8 例患者出现胸腔内疾病复发：2 例仅在 PTV 内，4 例在 PTV 内和远处，2 例在 PTV 外淋巴结复发加远处转移。31 例可评估患者中，3 级+急性食管炎和肺炎的发生率分别为 23%和 3%。在我们对 LD-SCLC 的研究中，基于 CT 成像省略 ENI 与孤立性淋巴结复发的高风险无关，但需要进一步的前瞻性研究来证实这一点。常规省略 ENI 将在正在进行的 III 期 CONVERT 试验（NCT00433563）中进行前瞻性评估。
