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Explore the radiotherapeutic clinical target volume delineation for small cell lung cancer with lower cervical lymph node metastasis according to CTimages

Ting Gao, Xiaopeng He, Yan Dang, Yindi Jiang, Youwen Yang, Yujuan Ma, Min Li, Shuli Yuan, Jianhui Chen

Background: In limited stage small cell lung cancer, involved field irradiation has been considered as standard. However, there have recent reports suggesting higher than expected nodal recurrence in the supraclavicular region. The study aimed to explore the reasonable radiotherapy range of supraclavicular zone for patients receiving prophylactic or radical radiation.

Patients and Methods: Supraclavicular zone was further divided into 4 zones, including upper pararecurrent laryngeal neural region (UP region), lower para-recurrent laryngeal neural region (LP region), medial supraclavicular region (MS region), and lateral supraclavicular region (LS region). And we analysed the distribution of lymph node metastasis in supraclavicular zone based on CT-images.

Results: our data showed that metastases occurred most frequently in the medial supraclavicular region (42.8%), followed by the lower para-recurrent laryngeal neural region (40.6%), lateral supraclavicular region (9.4%), and upper para-recurrent laryngeal neural region (7.2%), respectively.

Conclusion: If prophylactic irradiation therapy is considered, the target zones for prophylactic irradiation should include MS region and LP region as recommended.