RADIATION-THERAPY FOR INTRATHORACIC RECURRENCE OF NONSMALL CELL LUNG-CANCER

Fifty-two of 2,315 patients (2.4%) with non-small cell lung cancer (NS LC) treated with radiation therapy at the Mallinckrodt Institute of Ra diology and St. Luke's Hospital between 1975 and 1988 presented with l ocal recurrence after definitive surgery. No patient received radiatio n therapy after surgery as part of initial treatment and none had evid ence of distant metastases at the time of local recurrence. The median time to first recurrence was 14 months. At recurrence, patients prese nted with disease in the bronchial stump (eight patients), ipsilateral lung parenchyma (10), chest wall (six), regional lymph nodes (five), or some combination thereof (23). Sixty-five percent of patients had h istologic evidence of recurrence. Radiation therapy consisted of > 5,0 00 cGy in conventional fractionation to areas of gross disease in 35 o f 52 patients. Of 15 patients receiving > 6,000 cGy, 13 had a favorabl e-complete (CR) or partial (PR) response-tumor response to radiation t herapy. Among these patients, local control was achieved in 70% of pat ients with marginal recurrences (i.e., stump, parenchyma, or chest wal l) and in 50% with nodal recurrences. The median survival after radiat ion therapy for all patients was 8.5 months. The best indicators for l ong-term survival were the interval from initial surgery to first recu rrence and tumor response to radiation therapy.