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

Abstract

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.

Non–Small Cell Lung Cancer

“…Involved-field radiation to high dose without elective nodal irradiation has been shown to allow a higher dose of radiation with acceptable toxicity and low risk for isolated nodal relapse. 115,116,[125][126][127][128] It is essential to evaluate the dose-volume histogram of critical structures and to limit the doses to the spinal cord, lungs, heart, esophagus, and brachial plexus to minimize normal tissue toxicity (see Table 3 on page 762). These limits are largely empiric.…”

Locally Advanced Non-Small Cell Lung Cancer and Small Cell Lung Cancer

“…• When conformal techniques are utilized and the treating physician has performed a comprehensive evaluation of disease involvement, an involved fi eld approach is used for target volume delineation in NSCLC, due to the published low likelihood of disease recurrence in elective lymph nodes (Rosenzweig et al 2001(Rosenzweig et al , 2007 ). An involved fi eld technique plus inclusion of the ipsilateral hilum is also now recommended in the Radiation Therapy Oncology Group's (RTOG's) recent randomized trial examining the effect of dose on survival (RTOG 0538).…”

Involved-Field Radiation Therapy (IF-RT) for Non-Small Cell Lung Cancer (NSCLC)

“…They concluded that the incidence of nodal failure was low and did not seem to be due to high-dose incidental irradiation. Rosenzweig et al reported the results of IF-RT in a large number (524) of patients with stage I-III (65% stage III) NSCLC 8) . Only 32 patients (6.2%), 42 nodal regions with ENF were identified, and among the 42 nodal regions, six regional failures (14%) were in nodal regions that had incidentally received >45Gy, which is a typical dose of ENI.…”

“…The argument against the use of ENI may be summarized as follows 6,7) . 1) Failure is uncommon in nodal regions that are neither clinically involved nor specially targeted from many reports [8][9][10][11][12] .…”