Sir,
Elective nodal irradiation (ENI) was used in conventional radiotherapy (RT) target volume for limited-stage small-cell lung cancer (LS-SCLC) in contrast to involved-field RT only in some recent studies (Erridge and Murray, 2003). In contrast to non-small-cell lung cancer (NSCLC), where ENI was now less favoured (Senan et al, 2004), whether ENI could be safely omitted or not was less clear for LS-SCLC. To our knowledge, your article by Baas et al (2006) was the first prospective report regarding involved-field RT (i.e., omission of ENI). However, we felt that the data and conclusion reported in this study were not complete. The authors reported that local recurrences (within the target area) were seen in six patients (16%). It was concluded that combination chemotherapy with concurrent involved-field RT is an effective treatment for LS-SCLC. However, the number of nodal failures (within omitted ENI) was not reported. De Ruysscher et al (2006) reported that three patients (crude rate 11%, 95% CI 2.4–29%) developed an isolated nodal failure in a phase II study employing ENI. They concluded that the safety of selective nodal irradiation in NSCLC should not be extrapolated to patients with LS-SCLC until more data are available. We believe that the detail recurrence pattern in the study by Baas et al (2006) would be of great value in the issue of ENI in RT for LS-SCLC if this was reported formally in your journal, unless it was planned to be published elsewhere.
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References
Baas P, Belderbos JS, Senan S, Kwa HB, van Bochove A, van Tinteren H, Burgers JA, van Meerbeeck JP (2006) Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer: a Dutch multicenter phase II study. Br J Cancer 94: 25–30
Erridge SC, Murray N (2003) Thoracic radiotherapy for limited-stage small cell lung cancer: issues of timing, volumes, dose, and fractionation. Semin Oncol 30: 26–37
De Ruysscher D, Bremer RH, Koppe F, Wanders S, van Haren E, Hochstenbag M, Geeraedts W, Pitz C, Simons J, ten Velde G, Dohmen J, Snoep G, Boersma L, Verschueren T, van Baardwijk A, Dehing C, Pijls M, Minken A, Lambin P (2006) Omission of elective node irradiation on basis of CT-scans in patients with limited disease small cell lung cancer: a phase II trial. Radiother Oncol 80: 307–312
Senan S, Chapet O, Lagerwaard FJ, Ten Haken RK (2004) Defining target volumes for non-small cell lung carcinoma. Semin Radiat Oncol 14: 308–314
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Chien, CR., Yu, CJ. Involved-field radiotherapy in limited-stage small-cell lung cancer. Br J Cancer 97, 275 (2007). https://doi.org/10.1038/sj.bjc.6603862
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DOI: https://doi.org/10.1038/sj.bjc.6603862