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Metastatic spinal cord compression secondary to lung cancer
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350
DOES POSTOPERATIVE IRRADIATION AFFECT PULMONARY FUNCTION IN PATIENTS WITH NON-SMALL CELL LUNG CANCER (NSLC)? J. Van Meerbeeck, Ch. De Pooter, 0. Coolen, T. De Beukelaar, C. Vaerenberg, UZA, AZM, JPZ; Antwerp; Belgium.
MRTASTATIC SPINALCORD COMPRESSION SECONDARY TO LUNG CANCER. _Bach Agerlin N, S#rensen JB, Dombernowsky P, Hansen HH and Rasmussen TB, Sbrensen PS . From Departments of Oncology and University Hospital Herlet and Neurology, Rigshospitalet , Copenhagen, Denmark. A &view was performed bf all patients with spinal cord comnression (MSCC) secondarv to lung: cancer, in the east‘ern part if Denmark in the period-1979-1988. The series included 102 cases with Small Cell Carcinoma (SCLC) (41%)) Adenocarcinoma (27%), Squamous Cell Carcinoma (18%) and Large Cell Carcinoma (9%)) accounting for 95%. Sympto& and clinical findings are introduced. The outcome of treatment was estimated by chances in motor deficits and sphincter function. In the group of patients with non-SCLC 82% of the patients had benefit from treatment with laminectomy followed by radiotherapy compared with either laminectomy (47%) or radiotherapy (39%) alone (p= .03, Chi-square test). Of the patients with SCLC who were able to walk at the time of MSCC all remained ambulatory while 15% of the nonambulatory SCLC patients regained walking ability; in non-SCLC 95% of patients remained to have walking ability and 22% regained the ability to walk. No difference in survival was observed, between the different histological types of lung cancer and the different treatment modalities.
We retrospectively studied 91 patients with NSLC, treated between 1984 and 1990: 43 with surgery (S); 48 with surgery and irradiation (StIR). Mean age was 59 y and sex ratio 8.7, Stage distribution was 34 % St 1; 20 % St 2; 37 % St 3a and 9 % St 3b. Extent of resection included a lobectomy in 42 pts; a bi-lobectomy in 8 pts and a pneumonectomy in 41 pts. Postoperative irradiation consisted of 50 Gy in 5 weeks in 85 % of pts and of 46 Gy in 4.5 weeks in 15 %, administered by linear accelerator or CO-60. 3-v actuarial survival was 66 % (79 %S / 49 % StIR). _ Lung function was evaluated before, t 6 months after therapy and in 8 pts 6 wks postoperatively, preceePostoperative IR resulted in an additional dins IR. rediction in FEb-1 of 4.9 %; in VC of 4.3 X; in TLC of 0.5 % and in DLCO/AV of 12.6 %, as compared to values in non-irradiated ots. Pulmonarv function after irradiation showed i; all 8 pts a "slight increase in FEV-1 of 5 X: in VC of 10 % and in TLC of 6 %, as compared to 6 wks-postoperative values. Postoperative irradiation has limited detrimental effect on lung function, that however should be taken into account in patients with an already borderline preoperative lung function. The decision on IR should not be influenced by imnediate postoperative values.
351 TREATMENT AND PLANNING DECISIONS IN NON-SMALL CELL CARCINOMA OF THE LUNG - AN AUSTRALASIAN PAlTERNS OF PRACTICE STUDY Denham JD, Hamilton CS, Joseph DJ et al. Newcastle Mater MiserlcordiaeHospitalNSW Australia Fourteen practising Radiation Oncologistswere surveyed to assess their treatment and planning habits, utilising six unselected cases of Non-Small Cell Carcinoma of the Lung. Respondents were first given a general questionnaire,designed to evaluate their theoretical treatment and planning recommendationsbased on various tumour and patient-related variables. Respondents then undertook a practical planning exercise utilising planning CT and Simulator radiographs for each of the six sample cases. Each case was accompanied by a brief history and report outlining specific tumour The practical planning stage and non-stage related variables. exercise was repeated on the second day of the survey utilising different non-stage related variables but ldentlcal radiology and stage-related information. This design enabled firstly a comparison of clinicians’ intended policy and planning methods with actual policy and planning decisions, and secondly an assessment of intraclinicianvariabilityIn decisionmaking and planningpractice. Good agreement was evident aniong tilinicia~s~wfth respect 10 aeneral. non case-sceclflc treatment wllcles: however verv 5gnffldnt variation occikl at an Inter- aii& i&&inlcian level anh involved the entire treatment and planning process for individual cases. Despite identicaltreatment intent across identicalradiological case pairings, clinicians chose widely dlerlng margins and target volumes in their planningexercise. Treatment Intent appeared to be influenced more by non-stage related variables rather than stagerelated informationand radiological appearances per se. Non-stage related variables such as performance status, weight loss, arid Intercurrent disease, were found to impact on treatment policy significantly and principally in the more advanced stage disease cases. Patient socio-economic SKUIS may also have impacted on treatment intent.
352 PRIMARY TUMOUR VOLUME AS PROGNOSTIC FACTOR FOR BRONCHIAL CARCINOMA Oehler ,W., Eichhorn,H.-J., Potsdam-Germany The role of the primary tumour volume has been but rarely examined. However it is accepted that there is a clear correlation bet+ ween primary tumour mass and the level of tumour cell dissemination. Therefore It can be a useful prognostic indicator expecially for those tumours of which no evidence of metastasas can be proved with CT or MR. In case of 1022 patients, having been received a tumour dose more than 5600 cGys (on the 8% isodose curve) we examined the correlation between primary tumour volume, lymph node involvement, histologic type and overall survival, response on chest X-ray films, and tumour destruction in autopsy materials, respectively. We found: -there was a strong correlation, especislly in NO-cases, between primary tumour volume and overall survival, in all histologies. -Small regional metastatic tumours (Nl,NZ) had a better prognosis than that of great tumours with no metastases (NO), in all histologic types. -Small adenocarcinomas and large-cell turn= (NO) had a better prognosis than that of sqamous cell tumours of the same stage. -In 222 cases of Tl NO-tumours 5 yr.overall survival was 15.3%, in 43 cases of large41 tu ours an adenocarcinomas 28x, respectiI ve y.
350
DOES POSTOPERATIVE IRRADIATION AFFECT PULMONARY FUNCTION IN PATIENTS WITH NON-SMALL CELL LUNG CANCER (NSLC)? J. Van Meerbeeck, Ch. De Pooter, 0. Coolen, T. De Beukelaar, C. Vaerenberg, UZA, AZM, JPZ; Antwerp; Belgium.
MRTASTATIC SPINALCORD COMPRESSION SECONDARY TO LUNG CANCER. _Bach Agerlin N, S#rensen JB, Dombernowsky P, Hansen HH and Rasmussen TB, Sbrensen PS . From Departments of Oncology and University Hospital Herlet and Neurology, Rigshospitalet , Copenhagen, Denmark. A &view was performed bf all patients with spinal cord comnression (MSCC) secondarv to lung: cancer, in the east‘ern part if Denmark in the period-1979-1988. The series included 102 cases with Small Cell Carcinoma (SCLC) (41%)) Adenocarcinoma (27%), Squamous Cell Carcinoma (18%) and Large Cell Carcinoma (9%)) accounting for 95%. Sympto& and clinical findings are introduced. The outcome of treatment was estimated by chances in motor deficits and sphincter function. In the group of patients with non-SCLC 82% of the patients had benefit from treatment with laminectomy followed by radiotherapy compared with either laminectomy (47%) or radiotherapy (39%) alone (p= .03, Chi-square test). Of the patients with SCLC who were able to walk at the time of MSCC all remained ambulatory while 15% of the nonambulatory SCLC patients regained walking ability; in non-SCLC 95% of patients remained to have walking ability and 22% regained the ability to walk. No difference in survival was observed, between the different histological types of lung cancer and the different treatment modalities.
We retrospectively studied 91 patients with NSLC, treated between 1984 and 1990: 43 with surgery (S); 48 with surgery and irradiation (StIR). Mean age was 59 y and sex ratio 8.7, Stage distribution was 34 % St 1; 20 % St 2; 37 % St 3a and 9 % St 3b. Extent of resection included a lobectomy in 42 pts; a bi-lobectomy in 8 pts and a pneumonectomy in 41 pts. Postoperative irradiation consisted of 50 Gy in 5 weeks in 85 % of pts and of 46 Gy in 4.5 weeks in 15 %, administered by linear accelerator or CO-60. 3-v actuarial survival was 66 % (79 %S / 49 % StIR). _ Lung function was evaluated before, t 6 months after therapy and in 8 pts 6 wks postoperatively, preceePostoperative IR resulted in an additional dins IR. rediction in FEb-1 of 4.9 %; in VC of 4.3 X; in TLC of 0.5 % and in DLCO/AV of 12.6 %, as compared to values in non-irradiated ots. Pulmonarv function after irradiation showed i; all 8 pts a "slight increase in FEV-1 of 5 X: in VC of 10 % and in TLC of 6 %, as compared to 6 wks-postoperative values. Postoperative irradiation has limited detrimental effect on lung function, that however should be taken into account in patients with an already borderline preoperative lung function. The decision on IR should not be influenced by imnediate postoperative values.
351 TREATMENT AND PLANNING DECISIONS IN NON-SMALL CELL CARCINOMA OF THE LUNG - AN AUSTRALASIAN PAlTERNS OF PRACTICE STUDY Denham JD, Hamilton CS, Joseph DJ et al. Newcastle Mater MiserlcordiaeHospitalNSW Australia Fourteen practising Radiation Oncologistswere surveyed to assess their treatment and planning habits, utilising six unselected cases of Non-Small Cell Carcinoma of the Lung. Respondents were first given a general questionnaire,designed to evaluate their theoretical treatment and planning recommendationsbased on various tumour and patient-related variables. Respondents then undertook a practical planning exercise utilising planning CT and Simulator radiographs for each of the six sample cases. Each case was accompanied by a brief history and report outlining specific tumour The practical planning stage and non-stage related variables. exercise was repeated on the second day of the survey utilising different non-stage related variables but ldentlcal radiology and stage-related information. This design enabled firstly a comparison of clinicians’ intended policy and planning methods with actual policy and planning decisions, and secondly an assessment of intraclinicianvariabilityIn decisionmaking and planningpractice. Good agreement was evident aniong tilinicia~s~wfth respect 10 aeneral. non case-sceclflc treatment wllcles: however verv 5gnffldnt variation occikl at an Inter- aii& i&&inlcian level anh involved the entire treatment and planning process for individual cases. Despite identicaltreatment intent across identicalradiological case pairings, clinicians chose widely dlerlng margins and target volumes in their planningexercise. Treatment Intent appeared to be influenced more by non-stage related variables rather than stagerelated informationand radiological appearances per se. Non-stage related variables such as performance status, weight loss, arid Intercurrent disease, were found to impact on treatment policy significantly and principally in the more advanced stage disease cases. Patient socio-economic SKUIS may also have impacted on treatment intent.
352 PRIMARY TUMOUR VOLUME AS PROGNOSTIC FACTOR FOR BRONCHIAL CARCINOMA Oehler ,W., Eichhorn,H.-J., Potsdam-Germany The role of the primary tumour volume has been but rarely examined. However it is accepted that there is a clear correlation bet+ ween primary tumour mass and the level of tumour cell dissemination. Therefore It can be a useful prognostic indicator expecially for those tumours of which no evidence of metastasas can be proved with CT or MR. In case of 1022 patients, having been received a tumour dose more than 5600 cGys (on the 8% isodose curve) we examined the correlation between primary tumour volume, lymph node involvement, histologic type and overall survival, response on chest X-ray films, and tumour destruction in autopsy materials, respectively. We found: -there was a strong correlation, especislly in NO-cases, between primary tumour volume and overall survival, in all histologies. -Small regional metastatic tumours (Nl,NZ) had a better prognosis than that of great tumours with no metastases (NO), in all histologic types. -Small adenocarcinomas and large-cell turn= (NO) had a better prognosis than that of sqamous cell tumours of the same stage. -In 222 cases of Tl NO-tumours 5 yr.overall survival was 15.3%, in 43 cases of large41 tu ours an adenocarcinomas 28x, respectiI ve y.