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.
Keywords: Lung cancer; elective nodal irradiation; locoregional control
