Characteristics of two-year survivors after radiation therapy for inoperable non-small cell lung cancer

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CHARACTERISTICS OF TWO-YEAR SURVIVORS AFTER RADIATION THERAPY FOR INOPERABLE NON-SMALL CELL LUNG CANCER Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Maebashi, Gunma, Japan K. Hayakawa, Y. Saito, S. Katano, Y. Nakayama, H. Ikeda, T. Akiioto, K. Hayakawa, N. Nakajima, N. Mitsuhashi , H. Niibe. We analyzed the characteristics and treatment outcomes of two-year survivors after radiation therapy alone for non-small cell lung cancer(NSCLC). From 1975 to 1987, 210 patients with inoperable or unresectable clinical Stage I-III NSCLC were treated with radiation therapy alone. Seventy-four patients survived a minimum of 2 years. Histologic cell types included squamous cell carcinoma(57), adenocarcinoma(l2) and ethers(5). Five year survival rates after 2 years were 40% for the patients with squamous cell carcinoma and 17% for those with adenocarcinoma, respectively. In the patients without progression of the disease at two-years, 79% of patients with squamous cell carcinoma were free of cancer beyond 5 years and those with adenocarcinoma had only a 17% S-year-freedom from disease progression. Local primary progress occurred in 10% and distant failure in 7% of the patients with squamous cell carcinoma after 2 year disease-free survival. For seven adenocarcinoma patients without 2-years of disease progression, local relapse occurred in one patients and distant failure in 4 patients In the two-year survivors without progression of NSCLC after radiation therapy, death from squamous cell carcinoma of the lung is infrequent, in contrast to the patients with adenocarcinoma showing common late progression after 2 years.

A CASE OF MALIGNANT NEUROENDOCRINE TUMOR PRESENTING A HUGE MEDIASTINAL MASS CONTROLLED WITH RADIATION THERAPY M. Furuta, K. Hayakawa, Y. Saito, H. Suto, S. Nakamoto, T. Kazumoto, Y. Nakamura, N. Mitsuhashi, T. Nakajima, H. Niibe. Gunma University, Maebashi, Gunma, Japan. A 57-year-old male visited our hospital for swallowing disturbance and cough. Chest radiograph and CT revealed a huge posterior mediastinal tumor and thoracotomy was performed to find the tumor unresectable. Biopsy specimen at surgery showed tumor consisting of small round cells and positive to anti-NSE antibody, suggesting a malignant neuroendocrine tumor. As the mass grew despite administration of cisplatin, radiation therapy was given with a total dose of 56 Gy. The tumor disappeared with the treatment, but metastatic paravertebral tumor appeared just below the radiation portals two months after radiation therapy. Second course of radiation therapy was given to the new lesion and the tumor was controlled again. The patient is now well and free from the disease 42 months after the thoracotomy. We report a patient with unresectable huge mediastinal tumor derived from neuroendocrine tissue, which was controlled with radiation therapy.

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RADIATION-INDUCED APOPTOSIS OF SMALL CELL LUNG CANCER (SCLC) IN NUDE MICE. M. Hasegawa, M. Yamakawa, M. Furuta, S. Kate, T. Takahashi, T. Ohno, K. Hayakawa, N. Mitsuhashi, H. Niibe. Department of Radiology, Gunma University School of Medicine, Maebashi, Gunma, Japan. The purpose of this study is to evaluate the modes of radiation-induced cell death of radiosensitive SCLC. Human SCLC (GLS) serially transplanted into nude mice was irradiated with 200 kV X-rays ; single dose : 0.4 - 40 Gy, fractionated : 20 Gy Tumors were excised 6 hours in 10 fractions. 15 days after irradiation, and then they were fixed in 10 % formalin for microscopic examiImmunohistonation (hematoxylin and eosin). chemical stains were also performed by biotinstreptavidin method using apoptosis-associated For comparimonoclonal antibody BM-1 (JIMRO). son, more radiosensitive ependymoblastoma (NNE) and more radioregistant glioblastoma (KYG) transplanted into nude mice were also studied. GLS tumors irradiated with more than 10 Gy Incidence of apoptosis in showed shrinkage. them was increased significantly 6 - 12 hours It was higher than the after irradiation. incidence of radioregistant KYG tumor, however, lower than that of highly radiosensitive NNE GLS and KYG tumors irradiated with more tumor. than 10 Gy also showed prominent cellular pleomorphism 3 - 15 days after irradiation. These results suggest that the incidence of radiation-induced apoptosis is correlated with radiosensitivity.

RADIATION THERAPY

FOR NON-SMALL

CELL LUNG

CANCER WITH CHEST WALL INVASION Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Maebashi, Gunma, Japan Y. Saito, K. Hayakawa, M. Hasegawa, K. Shiojima, K. Maebayashi,

Y. Nakayama, S. Katano,

N . Nakajima, T. Nakajima, H . Niibe

The outcome of radiation therapy for non-small cell lung cancer (NSCLC) with chest wall invasion was investigated.

Two hundred

fourteen patients with Stage I-III NSCLC without malignant

pleural

effusion were treated by radiation therapy alone from 1976 to 1989. Fifty-one patients of them had the chest wall invasion: 31 had the superior sulcus tumors and 20 had the tumors invading other sites. Ten patients

had the evident destruction

Thirty-nine patients had squamous

of bony

thorax(DBT).

cell carcinoma and the remainder

had other histological types. All tumors were given at the total doses of 60-80Gy. In all cases, 2-year and 5 -year survival rates were 25% and lo%,

respectively.

Five year survival rate was 12% for the patients

without DBT and 0% for those with DBT. Prognosis with superior sulcus tumors was slightly better than

for the patients that for the

patients with the tumors invading other sites. Five year survival rate was 13% for squamous cell carcinoma and 0% for other histological types. Local relapse was recognized in 20 patients. Local relapse rate for the patients with DBT was higher than that for the patients without DBT. Pain relief was observed in all the patients with symptoms.