Radiotherapy for patients with medically inoperable stage I nonsmall cell lung carcinoma : Smaller volumes and higher doses-A review

✍ Scribed by Gregory S. Sibley

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 76 KB
• Volume: 82
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/(sici)1097-0142(19980201)82:3<433::aid-cncr2>3.0.co;2-q

✦ Synopsis

Background:

Surgical resection remains the treatment of choice for patients with stage i nonsmall cell lung carcinoma. however, there is a group of patients who are medically inoperable and are treated with radiotherapy alone. this review summarizes findings from published series of radiotherapy for patients with medically inoperable stage i lung carcinoma.

Methods:

A literature search was used to identify studies of treatment with radiotherapy alone for patients with medically inoperable stage i nonsmall cell lung carcinoma. ten studies that utilized megavoltage irradiation to doses of >55 gray (gy) in conventional fractionation were selected for analysis.

Results:

Radiotherapy doses were similar throughout the series, with a median dose of 60-66 gy. however, treatment volumes varied considerably, from small "postage stamp" fields to comprehensive lymph node coverage. averaging the results of these studies showed that approximately 15% of patients will be long term survivors, 25% will die of intercurrent disease, 30% will die of distant metastatic disease and 30% will die after local failure only. eight of ten series report grade 3-5 complications occurring in <2% of patients. analysis of treatment factors affecting survival revealed a consistent benefit of higher radiotherapy doses in terms of local control or disease free survival. no benefit from prophylactic lymph node irradiation was demonstrated.

Conclusions:

Despite the infirm nature of patients with medically inoperable stage i lung carcinoma, the majority will ultimately die of uncontrolled lung carcinoma. because complications are uncommon after doses of 60-66 gy, trials of dose escalation to limited fields are indicated for patients with medically inoperable nonsmall cell carcinoma in an attempt to improve overall survival.