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The role of radiotherapy as curative treatment in patients with stage III non-small cell lung cancer
404
Abstracts/L.mg Gmcer 14 (19%) 377-408
Radiographic changes following radiotherapy in the patients with lung cancer Yamwaki H, Tang JT, Inoue T, Teshima T, Ohtani M, Ikeda H et al. Dept. of Radiation and Oncology. Biomedical Research Center, Osaka University Medical School, Yamadaoko 2-2, Suira, Osaka 565. Strahlenther O&o1 1995; 171:272- 7. Backgrotmd: Radiation induced lung injury is an ominous adverse reaction in the management of thoracic disease by radiation therapy. Although the importance of the area of irradiated lung is well known, the irradiated area of mediastinum is little to be considered in the routine treatment. Purpose: To evaluate the significance of the irradiated area of the mediastinum in the simulation film for radiation induced lung injury. Parienrs andMerhodx A total of208 patients with primary lung cancer treated with radiation therapy were analyzed for incidence of radiation induced lung injury. Lung injury was defined as the appearance. of an abnormal shadow on the cheat radiograph. CT images were used to differentiate recurrence or other conditions. Age, sex, irradiation dose, irradiated lung area, T and N factors of the tumor, irradiated mediastinum area, performance status of patients, location of irradiated fields and use of chemotherapy were analyzed with Cox’s multivariate regression model. Resulrs: The cumulative rate of radiation induced lung injury at 12 months was 85%. Significant factor of radiation induced lung injury was irradiated area of the mediastinum (p = 0.03). Irradiated area of the lung (p = 0.18, n.s.), total tumor dose (p = 0. I, n.s.), use of chemotherapy (p = 0.08, n.s.) and location of irradiated tield @ = 0.08, n.s.) may also have an effect on radiation induced lung injury. Conclusion: The irradiated area of the media&urn is one of the significant factors in radiation induced lung injury.
Palliative radiation for stage 3 non-small cell lung cancer - A prospective study of two moderately high dose regimens Abratt RP. Shepherd IJ, MemeenaSalton XX. Department ofRadiation Oncology, Groore Schuur Hospiml, Observatory 7925, Cape Town. Lung Cancer (Ireland) 1995;13:137-43. Eighty four patients from GrooteSchuur Hospital and Frere Hospital East London were entered into a prospective randomised trial between January 1990 and December 1993. All the patients possessed non-small cell carcinoma (NSCLC) of the lung too extensive for radical irradiation and World Health Organization performance status O-2. The patients were randomised to receive either 35 Gy in 10 fractions (43 patients) or 45 Gy in 15 fractions (41 patients). In the patients treated to 35 Gy and 45 Gy, the median survival was 8,s months in both groups, the symptomatic response rate was 68% and 76% and the incidence of moderatetosevereradiationoeaophagitiswas23 46and41 % respectively. The latter approached statistical significance (P = 0.07, chi square). There was no evidence of a dose response effect on survival in the moderate dose range in patients treated palliatively for locally advanced NSCLC.
Survival following radiotherapy for post-surgical locoregional recurrence of non-small cell lung cancer bung J, Ball D, Worotniuk T, Lnidlaw C. Peter MacCallum Cancer InsUure, B Andrew’s Place, East Melbourne. Vie. 3002. Lung Cancer (Ireland) 1995;13:121 -7. Long term survival [ > 3 years] has been documented in patients treated with radiotherapy for bronchial stump recurrence following surgery for non-small cell lung cancer [NSCLC]. In this retrospective review of 45 patients with Iocoregional recurrence of NSCLC we measured survival following radiotherapy according to site of recurrence [bronchial stump or elsewhere] and treatment intent. Estimated median survival for all 45 patients from presentation was 10 months. Ten patients whose disease was confined to the bronchial stump had an estimated median survival of 15 months compared with 9 months for
patients with recurrence elsewhere [P = 0.411. Seventeen patients treated with radical intent [dose > 50 Gy] had an estimated median survival of 16 months, with an estimated 41% alive at two years. The overall survival of patients treated with radical intent is not dissimilar to that of a group of our patients treated similarly with primary radiotherapy for inoperable NSCLC. Weconclude that a policy of high dose radiotherapy may be justified in selected patients with recurrent NSCLC.
Endoluminal HDR brachytherapy as a palliative treatment of patients with recurrent previously irradiated non-small cell lung carcinoma MickeO, Pratt F-J, SchaferU, Wagner W, Potter R, Willich N. KliniW Polikl. far Strahlenrherapie, Radioonkologie, Westfalische WilhelmsUniversitar, Albert-Schweitzer-Srrasse 33, D-48129 Munsrer. St&leather Gnkol 1995;171:554-9. Purpose: The preferred primary treatment in non-small cell lung cancer is surgical resection. In fact, only less than 25% of patients are resectable with curative intent. The remaining patients are primarily treated with radiation therapy or combined radiochemotherapy, achieving remission rates up to 60 96 but Z-year survival rates of only about 5 % . Therefore an effective palliative treatment is important. The aim of our study was to show that using intraluminal HDR brachytherapy, tumorinduced bronchial obstruction and its symptoms can be relieved in the majority of cases. Patients at&Methods: Sixteen patients with recurrent previously irradiated non-small cell lung cancer were treated with intraluminal high dose rate iridium-192 afterloading irradiation at the Department of Radiotherapy and Radiation Oncology of the University of Munster between 1989 and 1993. There were 15 men and 1 woman with a median age of 61 years. As a primary treatment, 50 to 60 Gy had been delivered percutaneously. The recurrences were treated with HDR brachytherapy using 2 to 4 applications of 5 Gy to 6 Gy each to a tissue depth of 0.5 cm. Rest&s: In 13 of 16 patients dyspnoea could be improved and in 15 of 16 patients atelectasis could be dissolved. Nine of 16 patients achieved a partial or complete remission evaluated by bronchoscopic criteria. The median period of remission was 4 months. ihe median survival time, measured from the start of therapy and analysed using the Kaplan-Meier method, was only 9 months. As side effects, 1 pneumothorax and 1 tracheomediastinal tistula occurred, the latter presumably related to tumor progression. Conclusion: Our results show the importance ofintraluminal HDR brachytherapy in the palliative treatment of patients with recurrent non-small cell lung cancer.
The role of radiotherapy as curative treatment in patients with stage III non-small cell lung cancer Casas F, Ferrer F, CasaIs J, Sanchez-Reyes A, Biete A. Dpro. Oncologia Radiorerapica. Hospital Clinic i Provincial, CNillavoel 170, 08036 Barcelona. Gncologia (Spain) 1995;18:31-7. Design: T&is paper isadatareview ccmceming theroleofradiotherapy as curative treatmmt in patients with stage III non-small cell lung cancer (NSCL). Materials at&methods: CT scanning should be mandatory for optimal planning and therapy. Results: The date indicate that patients with stage III NSCLC will benefit from a combined treatment modality in terms of chemotherapy based on cisplatinum and radiotherapy. Conclusions: Combined modality can be subdivided into 3 categories: sequential, concomitant and alternated regimes. Implications for future clinical research will be discussed.
Combined treatment modalities Resection of stage III non-small cell lung cancer following induction therapy Rusch VW. Departmenr
of Surgery,
Memorial
Sloan-Kettering
Cancer
Abstracts/L.mg Gmcer 14 (19%) 377-408
Radiographic changes following radiotherapy in the patients with lung cancer Yamwaki H, Tang JT, Inoue T, Teshima T, Ohtani M, Ikeda H et al. Dept. of Radiation and Oncology. Biomedical Research Center, Osaka University Medical School, Yamadaoko 2-2, Suira, Osaka 565. Strahlenther O&o1 1995; 171:272- 7. Backgrotmd: Radiation induced lung injury is an ominous adverse reaction in the management of thoracic disease by radiation therapy. Although the importance of the area of irradiated lung is well known, the irradiated area of mediastinum is little to be considered in the routine treatment. Purpose: To evaluate the significance of the irradiated area of the mediastinum in the simulation film for radiation induced lung injury. Parienrs andMerhodx A total of208 patients with primary lung cancer treated with radiation therapy were analyzed for incidence of radiation induced lung injury. Lung injury was defined as the appearance. of an abnormal shadow on the cheat radiograph. CT images were used to differentiate recurrence or other conditions. Age, sex, irradiation dose, irradiated lung area, T and N factors of the tumor, irradiated mediastinum area, performance status of patients, location of irradiated fields and use of chemotherapy were analyzed with Cox’s multivariate regression model. Resulrs: The cumulative rate of radiation induced lung injury at 12 months was 85%. Significant factor of radiation induced lung injury was irradiated area of the mediastinum (p = 0.03). Irradiated area of the lung (p = 0.18, n.s.), total tumor dose (p = 0. I, n.s.), use of chemotherapy (p = 0.08, n.s.) and location of irradiated tield @ = 0.08, n.s.) may also have an effect on radiation induced lung injury. Conclusion: The irradiated area of the media&urn is one of the significant factors in radiation induced lung injury.
Palliative radiation for stage 3 non-small cell lung cancer - A prospective study of two moderately high dose regimens Abratt RP. Shepherd IJ, MemeenaSalton XX. Department ofRadiation Oncology, Groore Schuur Hospiml, Observatory 7925, Cape Town. Lung Cancer (Ireland) 1995;13:137-43. Eighty four patients from GrooteSchuur Hospital and Frere Hospital East London were entered into a prospective randomised trial between January 1990 and December 1993. All the patients possessed non-small cell carcinoma (NSCLC) of the lung too extensive for radical irradiation and World Health Organization performance status O-2. The patients were randomised to receive either 35 Gy in 10 fractions (43 patients) or 45 Gy in 15 fractions (41 patients). In the patients treated to 35 Gy and 45 Gy, the median survival was 8,s months in both groups, the symptomatic response rate was 68% and 76% and the incidence of moderatetosevereradiationoeaophagitiswas23 46and41 % respectively. The latter approached statistical significance (P = 0.07, chi square). There was no evidence of a dose response effect on survival in the moderate dose range in patients treated palliatively for locally advanced NSCLC.
Survival following radiotherapy for post-surgical locoregional recurrence of non-small cell lung cancer bung J, Ball D, Worotniuk T, Lnidlaw C. Peter MacCallum Cancer InsUure, B Andrew’s Place, East Melbourne. Vie. 3002. Lung Cancer (Ireland) 1995;13:121 -7. Long term survival [ > 3 years] has been documented in patients treated with radiotherapy for bronchial stump recurrence following surgery for non-small cell lung cancer [NSCLC]. In this retrospective review of 45 patients with Iocoregional recurrence of NSCLC we measured survival following radiotherapy according to site of recurrence [bronchial stump or elsewhere] and treatment intent. Estimated median survival for all 45 patients from presentation was 10 months. Ten patients whose disease was confined to the bronchial stump had an estimated median survival of 15 months compared with 9 months for
patients with recurrence elsewhere [P = 0.411. Seventeen patients treated with radical intent [dose > 50 Gy] had an estimated median survival of 16 months, with an estimated 41% alive at two years. The overall survival of patients treated with radical intent is not dissimilar to that of a group of our patients treated similarly with primary radiotherapy for inoperable NSCLC. Weconclude that a policy of high dose radiotherapy may be justified in selected patients with recurrent NSCLC.
Endoluminal HDR brachytherapy as a palliative treatment of patients with recurrent previously irradiated non-small cell lung carcinoma MickeO, Pratt F-J, SchaferU, Wagner W, Potter R, Willich N. KliniW Polikl. far Strahlenrherapie, Radioonkologie, Westfalische WilhelmsUniversitar, Albert-Schweitzer-Srrasse 33, D-48129 Munsrer. St&leather Gnkol 1995;171:554-9. Purpose: The preferred primary treatment in non-small cell lung cancer is surgical resection. In fact, only less than 25% of patients are resectable with curative intent. The remaining patients are primarily treated with radiation therapy or combined radiochemotherapy, achieving remission rates up to 60 96 but Z-year survival rates of only about 5 % . Therefore an effective palliative treatment is important. The aim of our study was to show that using intraluminal HDR brachytherapy, tumorinduced bronchial obstruction and its symptoms can be relieved in the majority of cases. Patients at&Methods: Sixteen patients with recurrent previously irradiated non-small cell lung cancer were treated with intraluminal high dose rate iridium-192 afterloading irradiation at the Department of Radiotherapy and Radiation Oncology of the University of Munster between 1989 and 1993. There were 15 men and 1 woman with a median age of 61 years. As a primary treatment, 50 to 60 Gy had been delivered percutaneously. The recurrences were treated with HDR brachytherapy using 2 to 4 applications of 5 Gy to 6 Gy each to a tissue depth of 0.5 cm. Rest&s: In 13 of 16 patients dyspnoea could be improved and in 15 of 16 patients atelectasis could be dissolved. Nine of 16 patients achieved a partial or complete remission evaluated by bronchoscopic criteria. The median period of remission was 4 months. ihe median survival time, measured from the start of therapy and analysed using the Kaplan-Meier method, was only 9 months. As side effects, 1 pneumothorax and 1 tracheomediastinal tistula occurred, the latter presumably related to tumor progression. Conclusion: Our results show the importance ofintraluminal HDR brachytherapy in the palliative treatment of patients with recurrent non-small cell lung cancer.
The role of radiotherapy as curative treatment in patients with stage III non-small cell lung cancer Casas F, Ferrer F, CasaIs J, Sanchez-Reyes A, Biete A. Dpro. Oncologia Radiorerapica. Hospital Clinic i Provincial, CNillavoel 170, 08036 Barcelona. Gncologia (Spain) 1995;18:31-7. Design: T&is paper isadatareview ccmceming theroleofradiotherapy as curative treatmmt in patients with stage III non-small cell lung cancer (NSCL). Materials at&methods: CT scanning should be mandatory for optimal planning and therapy. Results: The date indicate that patients with stage III NSCLC will benefit from a combined treatment modality in terms of chemotherapy based on cisplatinum and radiotherapy. Conclusions: Combined modality can be subdivided into 3 categories: sequential, concomitant and alternated regimes. Implications for future clinical research will be discussed.
Combined treatment modalities Resection of stage III non-small cell lung cancer following induction therapy Rusch VW. Departmenr
of Surgery,
Memorial
Sloan-Kettering
Cancer