| Objective:Local regional relapse is one of the most important factors which result in death for patients with local advanced non small cell lung cancer (NSCLC). If we can improve local control of the tumor, and don't increase the therapeutic side-effect of patients, then the patients' survival rate could be rised. Because pathological staging is the classical staging criteria for the tumor, and 18F-fluoro-deoxy-2-glucose positron emission tomography (18F-FDG-PET) has a high accurate in the staging of the mediastinal lymph nodes, thus, we make use of computed tomography (CT) findings combined with pathological staging or PET to reduce the clinical target volume(CTV) in three dimensional conformal radio therapy (3 D-CRT) for the patients with NSCLC. Regions of the mediastinal lymph node drainage where hadn't metastasis were not included in CTV. In order to decrease the injury of lung and oesophagus induced by irradiation, and insure the local regional control. Patients And Methods:The first part: Fifty-three patients with NSCLC had received 3D-CRT after radical surgery. All patients had been divided into group A and B randomly. Patients in group A, according to conventional method, had received preventive nodal irradiation (PNI) of the mediastinal lymph node drainage. Patients in group B, according to pathological nodal staging of post operation, hadn't received PNI of the area where hadn't metastasis. Thus, the average CTV of the patients in group B were smaller than those in group A. Patients in two group were treated with conventional fractionated radiotherapy (CFRT), received 2Gy in every one fraction, 5 fractions every week, and had received the same radiation dose. All patients were followed up over two years. Two years survival rate, local relapse of lymph node drainage and radiation injury of lung and oesophagus between group A and B had been compared.The second part: Seventy-six patients with NSCLC had received radical radiotherapy(RRT). Thirty-two patients had received 18F-FDG-PET (PETpatients) before RRT, these patients hadn't received PNI of mediastinal lymph node drainage where hadn't metastasis believed by CT combined with PET. Patients without PET(non-PET patients) had received PNI according to conventional method. The difference of CTV between two groups was 133.31+34.26cm3. All patients in two groups were treated with the same method . Peripheral lesions in lung were treated with low fractionated radiotherapy (LFRT), 6-8 Gy in every one fraction, 3 fractions in a week, and a total dose of 56-60 Gy were delivered in 7~10 fractions within 2-3 weeks. Lesions in hila and mediastinum were treated with AFRT, 3 Gy in every one fraction, 5 fractions in a week, a preventive dose of 42-45 Gy were delivered in 14-15 fractions within 3 weeks, and a radical radiation dose of 60-63 Gy were given in 20-21 fractions within 4~5 weeks. Two years survival rate, local control of lymph node drainage and irradiation injury of lung and oesophagus between the two groups had been compared.Statistical analysis: All data were analysed by the software packages of SPSS 10.0 Results:The first part: Two years survival rates of patients in two post-operation radiotherapy groups were 55.2 % and 62.5 % respectively (P=0.59). The local regional relapse rates and the recurrence out of CTV were 13.8%, 3.4% for group A and 16.7%, 8.3% for group B respectively (P=1 and P=0.571). There were no decrease of the local control in group B by the reduction of CTV. The radiation pneumonia and lung fibrosis rates were 6.9%, 62.1 % for group A and 0, 58.3% for group B respectively (P=0.459 and P=0.782). The radiation oesophagitis and oesophagus stricture rates were 37.9%, 6.9% for group A and 12.5%, 4.2%for group B respectively (P=0.039 and P=1). The incidence of radiation oesophagitis in group B were decreased significantly.The second part: Two years survival rate of RRT was 53.1% for PET patients and 43.2% for non-PET patients respectively (P=0.357). The distant metastasis rate was 25.0% for PET patients and 52.3% for non-PET...
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