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Introduction: Concurrent radiochemotherapy (RCHT) is standard treatment in locally advanced small cell lung cancer (SCLC) patients. Due to conflicting results on elective nodal irradiation (ENI) or selective node irradiation (SNI) there is no clear evidence on optimal target volumes. Therefore, the purposes of this study were to assess the sites of recurrent disease in SCLC and to evaluate the feasibility of SNI versus ENI. Methods: A retrospective single-institution study of 54 consecutive patients treated with RCHT was performed. After state-of-the-art staging, all patients underwent three-dimensional conformal radiotherapy to a total dose of 45 Gy in twice-daily fractions of 1.5 Gy starting concurrently with the first or second chemotherapy cycle. All sites of loco-regional recurrences were correlated to the initial tumor and dose delivered. The impact of potential prognostic variables on outcome was evaluated using the Cox-regression model. Results: After a median time of 11.1 months, 17 patients (31.5%) relapsed locally or regionally: six within the initial primary tumor volume, five within the initially affected lymph nodes, three metachronously within primary tumor and initially affected lymph nodes, and three both inside and outside of the initial nodal disease. All sites of loco-regional recurrence had received 92%-106% of the prescribed dose. Among all investigated co-factors only total GTV revealed a significant correlation with patient outcome. Conclusion: In our study most recurrences occurred within the primary tumor or initially affected lymph nodes, or distantly. We did not register any case of isolated nodal failure, supporting the use of selective nodal irradiation, possibly with the addition of supraclavicular irradiation in patients with nodal disease in the upper mediastinum.

Purpose: Concurrent radiochemotherapy (RCHT) is the standard treatment in locally advanced small cell lung cancer (SCLC) patients. Due to conflicting results on elective nodal irradiation (ENI) or selective node irradiation (SNI) there is no clear evidence on optimal target volumes. Therefore, the aims of this study were the evaluation of sites of recurrent disease in patients with limited stage SCLC undergoing radiochemotherapy to assess the feasibility and safety of SNI versus ENI and, moreover, the extraction of prognostic factors for loco-regional control, freedom from distant metastases and overall survival. Material and methods: A retrospective single-institution study was performed in 54 consecutive patients treated with RCHT. After state-of-the-art staging, all patients underwent three-dimensional conformal radiotherapy to a total dose of 45 Gy in twice-daily fractions of 1.5 Gy starting concurrently with the first or second chemotherapy cycle according to Turrisi et al. [1]. The gross tumour volume (GTV) consisted of the primary tumour and SNI visualized on CT and/or FDG-PET, or confirmed by cytology. The clinical target volume (CTV) was obtained by expanding the GTV, adjusting it for anatomical boundaries, and electively adding the supraclavicular lymph node stations. Thereafter, the CTV was expanded to a planning target volume based on institutional guidelines. Follow-up consisted of a 3-monthly chest x-ray or CT-scan. All sites of loco-regional recurrences were correlated to the initial tumour and dose delivered. The impact of potential prognostic variables on outcome was evaluated using the Cox-regression model. Results: After a median interval of 11.5 months, 17 patients (31%) relapsed locally or regionally: six within the initial primary tumour volume, five within the initially affected lymph nodes, three metachronously within primary tumour and initially affected lymph nodes, and three both inside and outside of the initial nodal disease. All sites o

Background: Concurrent radiochemotherapy (CCRT) is the standard treatment in locally advanced small cell lung cancer (SCLC) patients. Even though elective nodal irradiation (ENI) had been advocated, its use in routine clinical practice is still limited [van Loon, 2010]. Therefore, the purpose of this study is to assess the sites of recurrent disease in SCLC patients and to evaluate the feasibility of selective nodal irradiation (SNI) versus ENI. Methods: A retrospective single-institution study was performed in stage I-III SCLC patients treated with radical CCRT. After state-of-the-art staging, all patients underwent three-dimensional conformal radiotherapy to a total dose of 45 Gy in twice-daily fractions of 1.5 Gy starting concurrently with the first or second cycle of chemotherapy (etoposide, cisplatinum) cycle. The gross tumor volume (GTV) consisted of the primary tumor and SNI visualized on CT and/or FDG-PET, or confirmed by cytology. The clinical target volume (CTV) was obtained by expanding the GTV, adjusting it for anatomical boundaries, and electively adding the supraclavicular lymph node stations. Thereafter, the CTV was expanded to a planning target volume based on institutional guidelines. After CCRT, prophylactic whole-brain irradiation (WBI; 30 Gy in 15 fractions) was administered to patients with a (near-complete) response. Follow-up consisted of a CT-thorax 6-8 week after completing treatment, followed by a 3-monthly chest x-ray or CT-scan. For this retrospective analysis, we reviewed all imaging data used for radiation treatment planning and during follow-up. The site of loco-regional relapse was correlated to the initial site and dose delivered. Results: between April 2004 and December 2013, 54 patients underwent CCRT (followed by WBI in 63%). After a median time of 11.5 months, 17 patients (31.5%) had relapsed locally or regionally: six within the initial primary tumor volume, five within the initially affected lymph nodes, three metachronously wi

Background: Concurrent radiochemotherapy (CCRT) is the standard treatment in locally advanced small cell lung cancer (SCLC) patients. Even though elective nodal irradiation (ENI) had been advocated, its use in routine clinical practice is still limited [van Loon, 2010]. Therefore, the purpose of this study is to assess the sites of recurrent disease in SCLC patients and to evaluate the feasibility of selective nodal irradiation (SNI) versus ENI. Methods: A retrospective single-institution study was performed in stage I-III SCLC patients treated with radical CCRT. After state-of-the-art staging, all patients underwent three-dimensional conformal radiotherapy to a total dose of 45 Gy in twice-daily fractions of 1.5 Gy starting concurrently with the first or second cycle of chemotherapy (etoposide, cisplatinum) cycle. The gross tumor volume (GTV) consisted of the primary tumor and SNI visualized on CT and/or FDG-PET, or confirmed by cytology. The clinical target volume (CTV) was obtained by expanding the GTV, adjusting it for anatomical boundaries, and electively adding the supraclavicular lymph node stations. Thereafter, the CTV was expanded to a planning target volume based on institutional guidelines. After CCRT, prophylactic whole-brain irradiation (WBI; 30 Gy in 15 fractions) was administered to patients with a (near-complete) response. Follow-up consisted of a CT-thorax 6-8 week after completing treatment, followed by a 3-monthly chest x-ray or CT-scan. For this retrospective analysis, we reviewed all imaging data used for radiation treatment planning and during follow-up. The site of loco-regional relapse was correlated to the initial site and dose delivered. Results: between April 2004 and December 2013, 54 patients underwent CCRT (followed by WBI in 63%). After a median time of 11.5 months, 17 patients (31.5%) had relapsed locally or regionally: six within the initial primary tumor volume, five within the initially affected lymph nodes, three metachronously wi

Background: Concurrent radiochemotherapy (CCRT) is the standard treatment in locally advanced small cell lung cancer (SCLC) patients. Even though elective nodal irradiation (ENI) had been advocated, its use in routine clinical practice is still limited [van Loon, 2010]. Therefore, the purpose of this study is to assess the sites of recurrent disease in SCLC patients and to evaluate the feasibility of selective nodal irradiation (SNI) versus ENI. Methods: A retrospective single-institution study was performed in stage I-III SCLC patients treated with radical CCRT. After state-of-the-art staging, all patients underwent three-dimensional conformal radiotherapy to a total dose of 45 Gy in twice-daily fractions of 1.5 Gy starting concurrently with the first or second cycle of chemotherapy (etoposide, cisplatinum) cycle. The gross tumor volume (GTV) consisted of the primary tumor and SNI visualized on CT and/or FDG-PET, or confirmed by cytology. The clinical target volume (CTV) was obtained by expanding the GTV, adjusting it for anatomical boundaries, and electively adding the supraclavicular lymph node stations. Thereafter, the CTV was expanded to a planning target volume based on institutional guidelines. After CCRT, prophylactic whole-brain irradiation (WBI; 30 Gy in 15 fractions) was administered to patients with a (near-complete) response. Follow-up consisted of a CT-thorax 6-8 week after completing treatment, followed by a 3-monthly chest x-ray or CT-scan. For this retrospective analysis, we reviewed all imaging data used for radiation treatment planning and during follow-up. The site of loco-regional relapse was correlated to the initial site and dose delivered. Results: between April 2004 and December 2013, 54 patients underwent CCRT (followed by WBI in 63%). After a median time of 11.5 months, 17 patients (31.5%) had relapsed locally or regionally: six within the initial primary tumor volume, five within the initially affected lymph nodes, three metachronously wi