Re-examining the role of elective nodal irradiation: finding ways to maximize the therapeutic ratio.

摘要: Objective: Elective nodal irradiation (ENI) of regional lymphatics has been a foundational paradigm for radiation oncologists in the treatment nonsmall-cell lung cancer (NSCLC), but its utility recently calledinto question. This review summarizes controversies surrounding ENI and reviews therapeutic options available to treat NSCLC. Methods: Local failure after conventional radiotherapy (RT) occurs 40% 80% patients fueling investigation more aggressive RT regimens. As dose is increased accelerated volume normal tissue treated becomes limiting factor. Thus elimination followed by further escalation become commonly pursued solution. When excluded, restricted clinically positive disease negative lymph node stations are left untreated. Results: Radiographic surgical data suggest our ability determine true extent imperfect therefore likely leaves microscopic NSCLC Conclusions: At institution we have concluded that prophylactic nodes best reserved most achieve local control designing protocols including chemotherapy take advantage this improvement control.