Lung cancer: elective nodal irradiation

The goal of the treatment for lung cancer is to obtain local control, and as a result, to improve survival. In order to treat potentially subclinical disease, delivery of 40-50 Gy radiotherapy (RT) to the regional-nodal areas is designated as elective nodal irradiation (ENI). Increasing the volume of irradiated normal tissues with this approach leads to greater toxicity and prevents successful dose escalation. Advances in the staging of mediastinal disease and lower-than-expected elective nodal failure rates with involved nodal RT led to questions regarding the use of ENI, specifically, what is the target volume for postoperative irradiation? Restricted target volume usage with modern RT techniques has led to a negative effect on regional control due to inter- and intra-fraction motions, and it is questionable whether selective ENI is reasonable in curative treatment. This review evaluates the changes concerning the use of ENI over time.