LOCAL IRRADIATION ALONE FOR PERIPHERAL STAGE-I LUNG-CANCER - COULD WEOMIT THE ELECTIVE REGIONAL NODAL IRRADIATION

Purpose: The results of local irradiation only for patients with Stage I lung cancer were analyzed to see whether the treatment of regional lymph nodes could be omitted. Methods and Materials: One hundred and e ight medically inoperable patients with nonsmall cell lung cancer (T1 and peripheral T2) were treated with 60 Gy split course or 65 Gy conti nuous treatment, The target volume included the primary tumor only, wi thout regional lymph nodes, Response, survival, and patterns of failur e were analyzed. Results: The overall response rate was 85% with 50 (4 6%) complete responses (CRs). Overall survival at 3 and 5 years was 31 and 15%, and cancer-specific survival was 42 and 31% at 3 and 5 years , respectively. The actuarial 5 years local relapse free survival in p atients with a CR was 52%, Tumor size (less than or equal to 4 cm) was strongly correlated with the chance of complete remission and better survival, Of patients in complete remission, only two had a regional r ecurrence as the only site of relapse; an additional two patients had a locoregional recurrence. Conclusion: High-dose local radiotherapy on the primary tumor only is justified for medically inoperable patients with peripherally located nonsmall lung cancer, The low regional rela pse rate does not support the need for the use of large fields encompa ssing regional lymph nodes, Using small target volumes, higher doses c an be given and better local control rates can be expected.