Radical radiation therapy of advanced lung cancer. Evaluation of prognostic factors and results of continuous and split course treatment

Abstract

One hundred patients with inoperable (80) or unresectable (20) bronchogenic carcinoma without evidence of spread beyond the thorax and supraclavicular nodes were planned for radical radiotherapy. Seventy-six patients received continuous irradiation (6000 rads in 30 treatments in 6 weeks, TDF 99) and 24 received split course therapy (2 courses of 2500 rads in 10 treatments with a 3 week break between courses, TDF 88). Forty-three patients had squamous cell carcinoma or adenocarcinoma and were considered to have favorable prognostic factors, while 57 patients had unfavorable prognostic factors: undifferentiated large cell or small cell carcinoma, supraclavicular metastases, SVC obstruction, superior sulcus tumors, or bone erosion in continuity with the tumor.Ninety-two patients completed the planned course of treatment. In patients completing treatment, local control of cancer within the irradiated volume was achieved in 58.5% of continuously irradiated patients and 45.4% of patients receiving split course therapy.Median survival was 1.2 months in patients not completing treatment and 12 months for the patients who completed treatment; 19% of the total group survived 3 years. Median and 3 year survivals of 14 months and 20.4% and of 9 months and 11% were observed for patients treated continuously and by the split course techniques, respectively. Corresponding survival figures for patients with favorable and unfavorable prognostic signs were 21 months and 26%, and 4 months and 11%, respectively.Implications of these data for treatment planning and patient selection for radical radiotherapy in bronchogenic carcinoma are discussed.Cancer 44:446-456, 1979.UNG CANCER HAS BEEN identified as a L current major priority in health care in both the United States and the An estimated 98,000 new cases occurred in the

Improved survival with adjuvant external‐beam radiation therapy in lymph node‐negative pancreatic cancer

“…The SEER registry does not collect data regarding chemotherapy 21. However, past and current treatment practices in the United States suggest that most patients who are treated with adjuvant EBRT also receive chemotherapy 10, 13, 26, 27, 29–31. It is plausible that the survival advantage in our study may be the result of treatment with adjuvant chemotherapy rather than EBRT.…”

“…Most centers in the United States employ a continuous course of EBRT with total doses from 45 Gy to 54 Gy in fractions from 1.8 Gy to 2 Gy 16, 26. Although this regimen has not been investigated in a randomized study for pancreatic cancer, it has been shown to be more effective radiobiologically in other malignancies than a moderate‐dose, split‐course regimen 27. Additional methodological concerns regarding the delivery of radiation therapy remain.…”

Systemic therapy‐based split‐course stereotactic body radiation therapy

“…In addition, no significant differences were found in response, duration of response, survival, or toxicity between split‐ and short‐course radiotherapy 10 . Many other studies have shown that split‐course CRT, while reducing radiotherapy‐related toxicity, may in turn lead to impaired LC rates 11–19 . The prolongation of the total treatment time may cause an accelerated repopulation effect, leading to a decrease in the LC rate of malignancies, such as head and neck, bladder, and cervical cancers 20–22 .…”

“…10 Many other studies have shown that split-course CRT, while reducing radiotherapy-related toxicity, may in turn lead to impaired LC rates. [11][12][13][14][15][16][17][18][19] The prolongation of the total treatment time may cause an accelerated repopulation effect, leading to a decrease in the LC rate of malignancies, such as head and neck, bladder, and cervical cancers. [20][21][22] Moreover, the split-course CRT strategy prolongs the treatment time and increases the time-economic cost of treatment; therefore, this treatment strategy is used primarily in patients who cannot tolerate therapy toxicity, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] but also in other patients [41][42][43][44][45][46][47][48][49][50][51][52] in an era when CRT techniques are commonly used.…”

Simultaneous chemoradiation in advanced non‐small cell lung cancer

“…Complete and partial responses of 31 -92% were reported, representing an average of 50-55% response rate to sequential or simultaneous chemoradiation therapy in advanced lung cancer patients. Perez et a1 reported 50% local tumor control with radiation alone[21], while Emami et al[22] and Choi et al[23] had 59% and 76% tumor response (complete and partial) in unresectable lung cancer. Koning et al [I71 showed that weekly Cisplatin and RT did not improve local control or survival, but daily Cisplatin doses of 6 mg/m2 with RT provided statistically significant improvement in local control and 2 year survival.…”