Radiotherapy & Oncology
Volume 95, Issue 2 , Pages 178-184 , May 2010

Elective nodal irradiation (ENI) vs. involved field radiotherapy (IFRT) for locally advanced non-small cell lung cancer (NSCLC): A comparative analysis of toxicities and clinical outcomes

  • Annemarie T. Fernandes

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • Corresponding Author InformationCorresponding author. Address: University of Pennsylvania, 3400 Spruce Street, 2 Donner, PA 19104, USA.
    • ,
  • Jason Shen

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Jarod Finlay

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Nandita Mitra

      Affiliations

    • Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Tracey Evans

      Affiliations

    • Department of Medical Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • James Stevenson

      Affiliations

    • Department of Medical Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Corey Langer

      Affiliations

    • Department of Medical Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Lilie Lin

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Stephen Hahn

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Eli Glatstein

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Ramesh Rengan

      Affiliations

    • Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA

Received 16 October 2009 ,Revised 3 February 2010 ,Accepted 7 February 2010.

References 

  1. Lung Cancer. 10 June 2009. Centers for Disease Control and Prevention. <http://www.cdc.gov/cancer/lung/>; 6 July 2009.
  2. Halperin EC, Perez CA, Brady LW. Perez and Brady’s principles and practice of radiation oncology. 5th ed.. Philadelphia: Lippincott Williams & Wilkins; 2008;
  3. Le Chevalier T, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomized trial in 353 patients. J Natl Cancer Inst. 1991;83:417–423
  4. Saunders M, et al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet. 1997;350:161–165
  5. Perez CA, Stanley K, et al. A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Preliminary report by the Radiation Therapy Oncology Group. Cancer. 1980;45:2744–2753
  6. Rengan R, et al. Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004;60:741–747
  7. Belderbos JS, Heemsbergen WD, et al. Final results of a Phase I/II dose escalation trial in non-small-cell lung cancer using three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:126–134
  8. Kong FM, Ten Haken RK, et al. High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer: long-term results of a radiation dose escalation study. Int J Radiat Oncol Biol Phys. 2005;63:324–333
  9. Zhao L, West BT, et al. High radiation dose may reduce the negative effect of large gross tumor volume in patients with medically inoperable early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2007;68:103–110
  10. Graham AN, et al. Systematic nodal dissection in the intrathoracic staging of patients with non-small cell lung cancer. J Thorac Cardiovasc Surg. 1999;117:246–251
  11. Wu J, Ohta Y, et al. Nodal occult metastasis in patients with peripheral lung adenocarcinoma of 2.0cm or less in diameter. Ann Thorac Surg. 2001;71:1772–1777[discussion 1777–8]
  12. Gould MK, Kuschner WG, et al. Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med. 2003;139:879–892
  13. Bueno R, et al. Nodal stage after induction therapy for stage IIIA lung cancer determines patient survival. Ann Thorac Surg. 2000;70:1826–1831
  14. Wagner H, et al. Randomized phase 2 evaluation of preoperative radiation therapy and preoperative chemotherapy with mitomycin, vinblastine, and cisplatin in patients with technically unresectable stage IIIA and IIIB non-small cell cancer of the lung. LCSG 881. Chest. 1994;106:348S–354S
  15. Lin DY, Psaty BM, et al. Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics. 1998;54:948–963
  16. Mitra N, Heitjan DF. Sensitivity of the hazard ratio to non-ignorable treatment assignment in an observational study. Stat Med. 2007;26:1398–1414
  17. Cunlift PN, Mann JR, et al. Radiosensitivity in ataxia-telangiectasia. Br J Radiol. 1975;48:374–376
  18. Morgan JL, Holcomb TM, et al. Radiation reaction in ataxia telangiectasia. Am J Dis Child. 1968;116:557–558
  19. Rosenzweig KE, et al. Involved-field radiation therapy for inoperable non small-cell lung cancer. J Clin Oncol. 2007;25:5557–5561
  20. Kepka L, Bujko K, et al. Risk of isolated nodal failure for non-small cell lung cancer (NSCLC) treated with the elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) techniques – a retrospective analysis. Acta Oncol. 2008;47:95–103
  21. Yuan S, et al. A randomized study of involved-field irradiation versus elective nodal irradiation in combination with concurrent chemotherapy for inoperable stage III nonsmall cell lung cancer. Am J Clin Oncol. 2007;30:239–244
  22. Senan S, Burgers S, et al. Can elective nodal irradiation be omitted in stage III non-small-cell lung cancer? Analysis of recurrences in a phase II study of induction chemotherapy and involved-field radiotherapy. Int J Radiat Oncol Biol Phys. 2002;54:999–1006
  23. Grills IS, Yan D, et al. Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small-cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation, and elective nodal irradiation. Int J Radiat Oncol Biol Phys. 2003;57:875–890
  24. Fournel P, Robinet G, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe lyon-saint-etienne d’oncologie thoracique-groupe francais de pneumo-cancerologie NPC 95-01 study. J Clin Oncol. 2005;23:5910–5917
  25. Curran WJ, Scott CB, et al. Long-term benefit is observed in a phase III comparison of sequential vs. concurrent chemo-radiation for patients with unresected stage III NSCLC: RTOG 9410. ASCO 2003. 2003;22:621;[abstract 2499]
  26. Aydiner A, et al. Third-generation drugs in the chemoradiation of stage III non-small cell lung cancer (NSCLC): a meta-analysis of efficacy and toxicity parameters. ASCO 2009. 2009;[abstract 7536]
  27. Zinner RG, Komaki R, Cox JD, et al. Dose escalation of gemcitabine is possible with concurrent chest three-dimensional rather than two-dimensional radiotherapy: a phase I trial in patients with stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2009;73:119–127
  28. Novello S, Le Chevalier T. Use of chemo-radiotherapy in locally advanced non-small cell lung cancer. Eur J Cancer. 2002;38:292–299
  29. Schallier D, Bral S, Ilsen B, et al. Final overall results of a study with a novel triplet induction chemotherapy regimen (PACCAGE) followed by consolidation radiotherapy in locally advanced inoperable non-small cell lung cancer (NSCLC). J Thorac Oncol. 2009;4:728–735

PII: S0167-8140(10)00084-8

doi: 10.1016/j.radonc.2010.02.007

Radiotherapy & Oncology
Volume 95, Issue 2 , Pages 178-184 , May 2010

Article Tools

* Image Usage & Resolution