Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan.
Departments of Pulmonary Medicine, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan.
Nagoya J Med Sci. 2022 May;84(2):327-338. doi: 10.18999/nagjms.84.2.327.
Elective nodal irradiation (ENI) and involved field radiotherapy (IFRT) are definitive radiotherapeutic approaches used to treat patients with limited-disease small cell lung cancer (LD-SCLC). However, no solid consensus exists on their optimal target volume. The current study aimed to assess the clinical outcomes of patients with LD-SCLC who received definitive ENI or IFRT. A retrospective single-institution study of patients who received definitive radiotherapy between 2008 and 2020 was performed. All patients underwent whole-body positron emission tomography/computed tomography before three-dimensional conformal radiotherapy. Among the 37 patients analyzed, 22 and 15 received ENI and IFRT, respectively. The thoracic radiotherapy dose was mostly either 60 Gy in 30 fractions delivered in 2-Gy fractions once daily or 45 Gy in 30 fractions delivered in 1.5-Gy fractions twice daily. The median follow-up period was 21.4 months. A total of 12 patients (32%) experienced locoregional relapse: 10 within and 2 outside the irradiation fields. One patient in the IFRT group experienced isolated nodal failure. Differences in locoregional relapse-free, progression-free, and overall survival rates between ENI and IFRT were not significant. Overall, IFRT did not promote a significant increase in locoregional recurrence compared to ENI. Our findings suggested the utility of IFRT in standard clinical practice and support its use for patients with LD-SCLC.
选择性淋巴结照射(ENI)和累及野放疗(IFRT)是治疗局限期小细胞肺癌(LD-SCLC)患者的明确放射治疗方法。然而,对于它们的最佳靶区体积,目前尚无明确共识。本研究旨在评估接受明确 ENI 或 IFRT 治疗的 LD-SCLC 患者的临床结局。这是一项回顾性的单机构研究,纳入了 2008 年至 2020 年期间接受明确放疗的患者。所有患者在接受三维适形放疗前均接受全身正电子发射断层扫描/计算机断层扫描。在分析的 37 名患者中,22 名和 15 名分别接受了 ENI 和 IFRT。胸部放疗剂量大多为 60 Gy,30 次分割,2 Gy 分次,每天一次,或 45 Gy,30 次分割,1.5 Gy 分次,每天两次。中位随访时间为 21.4 个月。共有 12 名患者(32%)发生局部区域复发:10 名在照射野内,2 名在照射野外。IFRT 组有 1 名患者发生孤立性淋巴结失败。ENI 和 IFRT 组的局部区域无复发生存率、无进展生存率和总生存率差异无统计学意义。总体而言,IFRT 并未显著增加局部区域复发率。我们的研究结果表明 IFRT 在标准临床实践中的有效性,并支持其用于治疗 LD-SCLC 患者。