PURPOSE: To report the results of a prospective randomized study concerning the role of radiotherapy in the treatment of stage III, unresectable, asymptomatic non-small cell lung cancer. MATERIAL AND METHODS: Between 1992 and 1996, 240 patients with stage III, unresectable, asymptomatic non-small cell lung cancer were enrolled in this study, and sequentially randomized to one of the three treatment arms: conventional irradiation, hypofractionated irradiation and control group. In the conventional irradiation arm (79 patients), a dose of 50 Gy in 25 fractions in five weeks was delivered to the primary tumor and the mediastinum. In the hypofractionated irradiation arm (81 patients), there were two courses of irradiation separated by an interval of four weeks. In each series, patients received 20 Gy in five fractions in five days, in the same treatment volume as the conventional irradiation group. In the control group arm, 80 patients initially did not receive radiotherapy and were only observed. Delayed palliative hypofractionated irradiation (20-25 Gy in four to five fractions in four to five days) was given to the primary tumor when major symptoms developed. RESULTS: The two-year actuarial survival rates for patients in the conventional irradiation, hypofractionated irradiation and control group arms were 18%, 6% and 0%, with a median survival time of 12 months, nine months and six months respectively. The differences between survival rates were statistically significant at the 0.05 level. CONCLUSION: Although irradiation provides good palliation, the results are disappointing. The comparison of conventional and hypofractionated irradiation shows an advantage for conventional schedules.

Adult↗

PubMedDate not supplied

An evaluation of elective irradiation of neck nodes in patients with cancer of the supraglottic larynx.

Between 1964 and 1973, 152 patients with supraglottic cancer limited to the larynx with clinically negative neck were included in the controlled randomized study designed to evaluate elective irradiation of the neck. The patients were randomized to one of the 2 treatment groups: 1) "T+N": irradiation of the larynx and all neck nodes, tumor dose 5130 rad/6-7 weeks, 2) "T": irradiation of the laryngeal portals only, tumor dose 5130 rad/5 weeks. All patients received 250 kV orthovoltage irradiation. The biologic dose delivered to the larynx was greater in group "T" because of faster fractionation and shorter overall time of therapy. The calculated NSD value for the patients in group "T+N" varied from 1620 to 1690 ret, and in group "T" it was 1800 ret. Five-year survival rates with a preserved larynx and without cancer were 45.3% for group "T+N" and 66.2% for group "T". Seven patients of group "T" developed metastatic cancer in the neck, and 4 of them were cured by neck dissection. It is concluded that patients with early supraglottic cancer can be successfully irradiated through laryngeal portals only, including the larynx, and possibly midjugular and digastric nodes. The tumor dose should be at least equivalent to the NSD of 1800 ret in the condition of megavoltage therapy.

Carcinoma, Squamous Cell↗

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