Originally published as JCO Early Release 10.1200/JCO.2007.13.2191 on November 5 2007

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Involved-Field Radiation Therapy for Inoperable Non–Small-Cell Lung Cancer

Kenneth E. Rosenzweig, Sonal Sura, Andrew Jackson, Ellen Yorke

From the Departments of Radiation Oncology and Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Kenneth E. Rosenzweig, MD, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; e-mail: rosenzwk{at}mskcc.org

Purpose: Dose escalation has been shown to improve local control in non–small-cell lung cancer (NSCLC) treated with definitive radiation therapy, but with increased complications. We implemented the use of involved-field radiotherapy (IFRT) in an effort to reduce toxicity while treating the gross tumor to higher doses. This analysis reports failure rates in uninvolved nodal regions with the use of IFRT.

Patients and Methods: A total of 524 patients with NSCLC treated with three-dimensional conformal radiotherapy at Memorial Sloan-Kettering Cancer Center between 1991 and 2005 were reviewed. Only lymph node regions initially involved with tumor by either biopsy or radiographic criteria were included in the clinical target volume. Elective nodal failure (ENF) was defined as a recurrence in an initially uninvolved lymph node in the absence of local failure.

Results: Only 32 patients (6.1%) with ENF were identified. The 2-year actuarial rates of elective nodal control and primary tumor control were 92.4% and 51%, respectively, with a median follow-up of 41 months in survivors. In patients who achieved local disease control, the 2-year elective nodal control rate was 91%. The median time to ENF was 6 months (range, 0 to 56 months). Many patients experienced treatment failure in multiple lymph node regions simultaneously.

Conclusion: The use of IFRT did not cause a significant amount of failure in lymph node regions not included in the tumor volume. Therefore, IFRT remains an acceptable method of treatment that allows for dose escalation while minimizing toxicity.

published online ahead of print at www.jco.org on November 5, 2007.

Supported by Gant No. PO1-CA-59017 from the National Cancer Institute, National Institutes of Health.

Presented at the American Society for Therapeutic Radiation Oncology Annual Meeting, November 7, 2006, Philadelphia, PA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Editorial

• Low Incidence of Isolated Nodal Failures After Involved-Field Radiation Therapy for Non–Small-Cell Lung Cancer: Blinded by the Light?
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  JCO 2007 25: 5543-5545 [Full Text]

Related Correspondence

• Is There a Definitive Answer to the Question of Involved-Field Radiotherapy for Inoperable Non–Small-Cell Lung Cancer?
  Carlos Genesio Bezerra Lima, Jr and Arno Lotar Cordova, Jr
  JCO 2008 26: 2235 [Full Text]

This article has been cited by other articles:

				C. G. B. Lima Jr and A. L. Cordova Jr Is There a Definitive Answer to the Question of Involved-Field Radiotherapy for Inoperable Non-Small-Cell Lung Cancer? J. Clin. Oncol., May 1, 2008; 26(13): 2235 - 2235. [Full Text] [PDF]

				B. Jeremic Low Incidence of Isolated Nodal Failures After Involved-Field Radiation Therapy for Non Small-Cell Lung Cancer: Blinded by the Light? J. Clin. Oncol., December 10, 2007; 25(35): 5543 - 5545. [Full Text] [PDF]