PET-CT use and the occurrence of elective nodal failure in involved field radiotherapy for non-small cell lung cancer: A systematic review

Aim: Current guidelines do not recommend the use of elective nodal irradiation for NSCLC, for several reasons. One of these is that PET-CT provides adequate nodal staging. We compared the published rates of elective nodal failures (ENFs) defined as regional failures that occur without local recurrence irrespectively of distant metastases status in patients who did or did not undergo PET-CT for staging. Methods: Reports of the occurrence of ENFs were considered. Only studies that used involved fields and specified the number of ENFs in patients with and without PET-CT use were included. A chi-squared test was used for the comparison of the risk of ENF in patients staged with and without PET. Results: Forty-eight studies were included; 2158 and 1487 patients with and without PET-CT performed before radiotherapy were identified. The proportion of patients treated with SBRT was higher in the group with PET-CT (71%) than it was in the group without PET-CT (20%; p < .001). There were 136 (6.3%) and 98 (6.6%) ENFs in patients with and without PET-CT, respectively (p = .74). Conclusion: The failure to reduce ENF by PET-CT was demonstrated. These data should be regarded in the context of the adequacy of reporting the rate of ENF and recognized value of PET-CT in NSCLC treatment. (C) 2015 Elsevier Ireland Ltd. All rights reserved.