RADIOTHERAPY ALONE FOR NONSMALL CELL LUNG-CARCINOMA - 5-YEAR DISEASE-FREE SURVIVAL AND PATTERNS OF FAILURE

One hundred and fifty-three patients with inoperable non-small cell lu ng cancer (NSCLC) treated with radiotherapy alone have been retrospect ively analysed, Normalized Total Dose (NTD) as defined by Macejewski, TN-stage (AJC-system) and histology have been examined with respect to 5-year disease-free survival (DFS) and the patterns of failure so as to identify subgroups of patients that routinely should be treated wit h radical intent, The 5-year DFS for T1, 2-N0, 1 and T3-N0, 1 staged p atients was 30% (7/23) and 25% (4/16) respectively when the tumor NTD (a/b=10 Gy) was 56-64 Gy vs, 12% (5/41) and 0% (0/10) when the NTD was 48-55 Gy, This difference was statistically significant for the squam ous cell histology group, The higher doses significantly altered the p atterns of death in N0, 1 staged squamous cell carcinoma and adenocarc inoma patients, Forty-five percent (22/55) and 41% (12/29) of squamous cell and adenocarcinoma patients respectively, died from local relaps e without evidence of distant metastases when NTD less than 55 Gy were given vs, 21% (9/42) and 13% (2/15) when the NTD delivered was 56-64 Gy (p < 0.05), Although for N2, 3 staged patients or patients with dir ect extension of the tumor into the mediastinum death from local relap se occurred in 38% (10/26) of the high NTD treated patients vs. 51% (1 9/37) of the low-dose treated ones, the difference was not statistical ly significant, It is concluded that NSCLC patients should not a prior i be considered as non-radiocurable, At least 30% of the patients with early local stages can be long-term disease-free survivors with radia tion NTD up to 60 Gy and better results are to be expected with higher doses, Advanced T-stage without mediastinal involvement should be tre ated with radical intent since a high NTD could give cure rates of ove r 25%, The disappointing results for patients with mediastinal disease could perhaps be attributed to the low NTD delivered, For patients wi th good performance status, hyperfractionated regimens delivering high tumor doses should be tested and chemotherapy should be adapted to th ese radiation treatment schedules.