LUNG-CANCER

This synthesis of the literature on radiotherapy for lung cancer is ba sed on 80 scientific articles, including 2 meta-analyses, 29 randomize d studies, 19 prospective studies, and 21 retrospective studies. These studies involve 28172 patients. Basic treatment for limited-stage sma ll cell lung cancer (SCLC), is chemotherapy. Addition of radiotherapy to the primary tumor and mediastinum reduces local recurrence, prolong s long-term survival, and is often indicated. Current, and future, stu dies can be expected to show successive improvements in results for SC LC by optimizing the combination of radiotherapy and chemotherapy. Sho uld these treatments be given simultaneously or sequentially, and in w hich order? Which fractionation is best? Probably, no change in resour ce requirements for radiotherapy will be necessary, with the possible exception of changes in fractionation. Surgery constitutes primary tre atment for nonsmall cell lung cancer (NSCLC) stages I and II. Radiothe rapy may provide an alternative for patients who are inoperable for me dical reasons. The value of radiotherapy following radical surgery for NSCLC remains to be shown. It is not indicated based on current knowl edge. For NSCLC stage III, radiotherapy shrinks tumors and prolongs su rvival at 2 and 3 years. Whether it influences long-term survival afte r 5 years has not been shown. Considering the side effects of treatmen t, one must question whether limited improvements in survival motivate routine radiotherapy in these patients. Earlier attempts to add chemo therapy to radiotherapy to improve treatment results of NSCLC have not yielded convincing results. Several studies are currently on-going. P rophylactic cranial irradiation (PCI) greatly reduces the risk for bra in metastases from SCLC. However, it has little influence on survival. Many treatment centers give PCI to SCLC patients who have achieved co mplete remission. This practice may be questioned since PCT is associa ted with serious complications. PCI is not indicated in patients with NSCLC. In SCLC, where the disease is extensive, only palliative radiot herapy is appropriate.