Elective nodal failures are uncommon in medically inoperable patients with Stage I non-small-cell lung carcinoma treated with limited radiotherapy fields.

Abstract

PURPOSE:

To review the outcome for 56 Stage I non-small-cell lung cancer treated definitively with three-dimensional conformal radiotherapy (3D-CRT) and to investigate the value of elective nodal irradiation in this patient population.

METHODS AND MATERIALS:

Between 1992 and 2001, 56 patients were treated with 3D-CRT for inoperable Stage I histologically confirmed non-small-cell lung cancer; 31 with T1N0 and 25 with T2N0 disease. All patients were treated with 3D-CRT to a median isocenter dose of 70 Gy (range 59.94-83.85) given in daily doses of 1.8 or 2 Gy. Prognostic factors were analyzed with respect to their impact on overall survival. Twenty-two patients received radiotherapy (RT) directed to elective regional lymphatics to doses of 45-50 Gy. The remaining 33 patients were treated to limited fields confined to the primary lung cancer with a margin. The patterns of failure were reviewed.

RESULTS:

The median follow-up was 20 months (range 6 months to 6 years). The actuarial local control rate was 88%, 69%, and 63%, at 1, 2, and 3 years, respectively. The actuarial cause-specific survival rate was 82%, 67%, and 51% at 1, 2, and 3 years, respectively. The actuarial overall survival rate was 73%, 51%, and 34% at 1, 2, and 3 years, respectively. The actuarial metastasis-free survival rate was 90%, 85%, and 81% at 1, 2, and 3 years, respectively. The RT dose was the only factor predictive of overall survival in our analysis. No statistically significant difference was noted in cause-specific or overall survival according to whether patients received elective nodal irradiation. Two of 33 patients treated with limited fields had regional nodal failure.

CONCLUSION:

Many patients with medically inoperable Stage I lung cancer die of intercurrent causes. The omission of the elective nodal regions from the RT portals did not compromise either the cause-specific or overall survival rate. Elective nodal failures were uncommon in the group treated with limited RT fields. A radiation dose 70 Gy was predictive of better survival in our population. We await the results of prospective trials evaluating high-dose RT in patients treated with RT alone for Stage I lung cancer.

• Authors: Jeffrey D Bradley, Sasha Wahab, Mary Ann Lockett, Carlos A Perez, James A Purdy
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 56 Issue 2 Pg. 342-7 (Jun 01 2003) ISSN: 0360-3016 [Print] United States
• PMID: 12738307 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Non-Small-Cell Lung (mortality, pathology, radiotherapy)
• Esophagitis (etiology)
• Female
• Follow-Up Studies
• Humans
• Lung Neoplasms (mortality, pathology, radiotherapy)
• Lymphatic Irradiation
• Male
• Middle Aged
• Neoplasm Staging
• Proportional Hazards Models
• Radiation Injuries (complications)
• Radiation Pneumonitis (etiology)
• Radiotherapy, Conformal (methods)
• Survival Analysis