Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review

Abstract

Objectives-To determine the eVectiveness of radical radiotherapy in medically inoperable stage I/II non-small cell lung cancer (NSCLC) and the extent of treatment related morbidity. Methods-Randomised trials were sought by electronically searching the Cochrane Clinical Trials Register, and both randomised and non-randomised trials were sought by searching Medline and Excerpta Medica (Embase). Further studies were identified from references cited in those papers already identified by electronic searching. The studies included were those of patients of any age with stage I/II NSCLC receiving radiotherapy at a dose of >40 Gy in 20 fractions over 4 weeks or its radiobiological equivalent. Results-Two randomised and 35 nonrandomised studies were identified. One randomised and nine non-randomised studies did not meet the selection criteria, leaving one randomised and 26 nonrandomised studies for analysis. In the randomised trial 2 year survival was higher following continuous hyperfractionated accelerated radiotherapy (CHART; 37%) than following 60 Gy in 30 fractions over 6 weeks (24%). An estimated 2003 patients were included in the 26 non-randomised studies; overall survival was 22-72% at 2 years, 17-55% at 3 years, and 0-42% at 5 years. Following treatment, 11-43% of patients died from causes other than cancer. Cancer specific survival was 54-93% at 2 years, 22-56% at 3 years, and 13-39% at 5 years. Complete response rates were 33-61% and local failure rates were 6-70%. Distant metastases developed in approximately 25% of patients. Better response rates and survival were seen in those with smaller tumours and in those receiving higher doses although the reasons for prescribing higher doses were not clearly stated. The outcome was worse in those with prior weight loss or poor performance status. Assessment of treatment related morbidity and eVects on quality of life and symptom control were inconclusive because of the lack of prospective evaluation and paucity of data. Conclusions-No randomised trials compared a policy of immediate radical radiotherapy with palliative radiotherapy given when patients develop symptoms. In the absence of such trials, radical radiotherapy appears to result in a better survival than might be expected had treatment not been given. A substantial, though variable, proportion of patients died during follow up from causes other than cancer. The optimal radiation dose and treatment technique (particularly with respect to mediastinal irradiation) remain uncertain. (Thorax 2001;56:628-638)

An assessment of cone beam CT in the adaptive radiotherapy planning process for non-small-cell lung cancer patients

“…Nine patients' cbctGTV1 (mean 77. 4 A correlation between pGTV and cbctGTV1 volume was evident (r 2 5 0.932) (Figure 1). …”

“…4 respectively. Comparing weekly volumes to cbctGTV1, the mean ratios (6SD) were cbctGTV2, 0.93 6 0.08; cbctGTV3, 0.84 6 0.12; and cbctGTV4, 0.75 6 0.14 showing a trend towards volume reduction with increasing dose.…”

“…Numerous studies have reported on the response of NSCLC to radiation treatment and its significant role in patient care. 4,5 Radiation can cause many toxic side effects for the patient including pneumonitis and pulmonary fibrosis 6 and is an important consideration in designing treatment approaches.…”

Bronchoscopy-Guided Cooled Radiofrequency Ablation as a Novel Intervention Therapy for Peripheral Lung Cancer

“…Surgery is recognized as the standard treatment for patients with early stage non-small-cell lung cancer (NSCLC) [3]. However, surgery is not indicated in patients with cardiovascular, pulmonary and other medical comorbidities [4,5,6,7]. An increasing proportion of elderly patients with NSCLC could be associated with such medical comorbidities [6].…”

Hypofractionated 3D radiotherapy for inoperable T1-3 N0-1 non-small-cell lung cancer

“…A 2-year OS of 60% and primary control rate of 80% suggest that HFRT is safe and has better results than those obtained with more conventional schedules, as reported in the past. 20 The results of this study were achieved with rather simple RT technical requirements, i.e. fast and slow CTs, 3D dose planning and portal vision imaging for treatment verification.…”