Abstracts/Lung thus allowing an accurate verification with large dose gradients.
of the dose delivered
Cancer I5 (19%) 139-157
Local irradiation alone for peripheral stage I lung cancer: Could we omit the elective regional nodal irradiation? Krol ADG, Aussems P, Noordijk EM, Hermans J, Leer JWH. Depnnmenf of Clinical Oncology, University Hospital Leiden, P. 0. B. 9600, 23OORCLeiden. Int J Radiat Gncol Biol Phys 1996;34:297-302. Purpose: The results of local irradiation only for patients with Stage I lung cancer were analyzed to see whether the treatment of regional lymph nodes could be omitted. Methods arm’ Materials: One hundred and eight medically inoperable patients with nonsmall cell lung cancer (Tl and peripheral T2) were treated with 60 Gy split course or 65 Gy continuous treatment. The target volume included the primary tumor only, without regional lymph nodes. Response, survival, and patterns of failure were analyzed. Results: The overall response rate was 85 % with 50 (46 96) complete responses (CRs). Overall survival at 3 and 5 years was 3 1 and 15 46, and cancer-specific survival was 42 and 3 1% at 3 and 5 years, respectively. The actuarial 5 years local relapse free survival in patients with a CR was 52%. Tumor size (‘k4 cm) was strongly correlated with the chance of complete remission and better survival. Of patients in complete remission, only two had a regional recurrence as the only site of relapse; an additional two patients had a locoregional recurrence. Conclusion: High-dose local radiotherapy on the primary tumor only is justified for medically inoperable patients with peripherally located nonsmall lung cancer. The low regional relapse rate does not support the need for the use of large fields encompassing regional lymph nodes. Using small target volumes, higher doses can be given and better local control rates can be expected.
Combined treatment modalities Effect of interfraction interval in hyperfractionated radiotherapy with or without concurrent chemotherapy for stage III nonsmall cell lung cancer Jeremic B, Shibamoto Y. Department of Oncology, Chest Disease Research Institute. Kyoto University, Kyoto 404-01. Int J Radiat Oncol Biol Phys 1996; 34:303-g. Purpose: To explore the influence of interfraction interval in hyperfractionated radiotherapy (HFX RT) with or without concurrent chemotherapy for Stage III nonsmall cell lung cancer. Metho& and Materials: One hundred sixty-nine patients treated in a randomized study were retrospectively analyzed. Group I patients were treated by HFX RT with 1.2 Gy twice daily with a total dose of 64.8 Gy in 27 treatment days, while Groups II and III patients were treated by the same HFX RT and concurrent chemotherapy with carboplatin and etoposide (every weekinGroupIIandeveryotherweekinGroupII1). Interfraction intervals of either4.5-5 h or 5.5-6 h were used for each patient. Results: Patients treated with shorter interfraction intervals (4.5-5 h) had a better prognosis than those treated with longer intervals (5.5-6 h) (median survival: 22 vs. 7 months; 5-year survival rate: 27% vs. OR, p = O.OOOOO). This phenomenon was observed in all treatment groups. Patients 60 years of age, with Stage IIIA disease, or with previous weight loss JR 5 96were treated more often with the shorter intervals than those < 60 years, with Stage BIB disease, or with weight loss > 5 96, respectively, but in all of these subgroups of patients, the shorter intervals were associated with a better prognosis. Multivariate analysis showed that the interfraction interval was an independent prognostic factor, together with sex, age, performance status, and stage. The shorter intervals were associated with an increased incidence of acute highgrade toxicity, but not with an increase in late toxicity. Conclusion: Patients treated with shorter interfraction intervals (4.5-5 h) appeared to have a better survival than those treated with longer intervals (5.5-6 h). Prospective randomized studies are warranted to further investigate the influence of inter-fraction interval in HFX RT.