REVIEW OF THE CURATIVE ROLE OF RADIOTHERAPY IN THE TREATMENT OF NONSMALL CELL LUNG-CANCER

The present paper is a comprehensive review of available data concerni ng the role of radiotherapy as an intended curative treatment in patie nts with non-small cell lung cancer (NSCL). The following issues are r eviewed (1) optimal dose, (2) optimal fractionation, (3) optimal treat ment planning, (4) clinical results in terms of single treatment and c ombined treatment with either surgery or chemotherapy. In resectable N SCLC high dose ratiotherapy to small localized tumours gives a 5-year survival rate of 7-38%. It is concluded that this treatment modality i s appropriate for certain selected patients who refuse to have surgery , who have medical contradictions for surgery, or who are of old age. It is discussed whether the treatment should be split course, continuo us, hypo-og hyperfraction. A total dose of 55 Gy must be given. CT sca nning should be mandatory for optimal planning and therapy. The litera ture does not give a conclusive answer to whether preoperative or post operative radiotherapy is indicated. The data indicate that patients w ith Stage III NSCLC will benefit from a combined treatment modality in terms of chemotherapy based on high dose cisplatinum and radiotherapy . The main conclusion of the review is that many areas with randomized controlled trials are needed in order to answer the critical issue of the role of radiotherapy in the treatment of NSCLS.