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    Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer - Evidence from a phase II trial.

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    Authors
    Colaco, Rovel J
    Sheikh, Hamid Y
    Lorigan, Paul C
    Blackhall, Fiona H
    Hulse, Paul
    Califano, Raffaele
    Ashcroft, Linda
    Taylor, Paul
    Thatcher, Nick
    Faivre-Finn, Corinne
    Affiliation
    Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
    Issue Date
    2012-04
    
    Metadata
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    Abstract
    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 (66Gy in 33 fractions) or twice-daily (45Gy 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 ≥1cm 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).
    Citation
    Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer - Evidence from a phase II trial. 2012, 76 (1):72-7 Lung Cancer
    Journal
    Lung Cancer
    URI
    http://hdl.handle.net/10541/219571
    DOI
    10.1016/j.lungcan.2011.09.015
    PubMed ID
    22014897
    Type
    Article
    Language
    en
    ISSN
    1872-8332
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.lungcan.2011.09.015
    Scopus Count
    Collections
    All Christie Publications
    Medical Oncology
    Clinical Oncology

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