361

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362

NON-CONVENTIONAL FRACTIONATED RADIOTHERAPY IN THE TREATMENT OF PATIENTS WITH NON SMALL CELL LUNG CRNCER - WestlinJ-E, Hallbus-Maripuu A-K, Brodin

0. - Department of Onoology, University Hospital, uppsala, Sweden Patients with non resectable NSCLC, limited disease are in many institutions treated with radiotherapy. vocal control is, however, very limited. In the search for more efficient radiotherapy a non convent- ional fractionation schedule was applied and prelimin- ary results are no" obtained. Material: Thirty-six cases with non resectable lung cancer, 16 with adeno- carcinoma, 10 with squamous cell carcinoma, 4 with large cell carcinoma and 6 with mixed types of non small cell carcinoma "era treated with radiotherapy. The fractionation schedule included 4 treatment with higher doses between 4-6 Gy to a target volume includ- ing only the primary tumour and avoiding the medulla and a further 47-48 Gy were delivered with 2 Gy fract- ions, including both the tumour and regional lymph nodes. The higher dose-fractions were given 2 at the start and 2 in the middle of the treatment. Result: Complete remission was observed according to radiographs of the lung in 6 cases and partial remission in a fairly high number of cases. HOWeVer, long term survival was not improved.

363

Surgery (S) vs surgery + radiotherapy

T2- N non small cell lung carcinoma

An s&&is of mean term data. S. Basso Ricci, F. Milani, A. Gramaglia, S. Istituto Nazionale Tumori. Hilano - Italy.

(S+RT) in (NSCLC).

Villa.

180 patients undergone surgery for T2 Nl_2 NSCLC were randomly assigned to receive RT or no further treatment (accrual period 1983 - 1987). 132 (78 S, 56 S+RT) out of 180 patients were evaluable. Istologies were distribuited as follows: 43 (55%) squamous cell ca., 24 (31%) adenoca., 11 (14%) large cell in surgery group; 28 (52,5%) squamous cell ca., 19 (35%) adenoca., 7 (11,5%) large cell in combined group. 48 patients were escluded: 31 for not radical surgery, 12 lost out follow-up, 5 for detection of metastases at less than 45 days from surgery. Locoregional failure occured in 19/78 (24%) of surgery vs 7/56 (12,5%) of S+RT group. Distant metastases: brain 15/78 (19%) of surgery vs lo/54 (18,5%); other than brain 35/78 (45%) vs 22/54 (41%). 9 patients are alive NED after surgery alone (12%) while 15 after combined treatment (26%).

Prospective study confronting wide field RT versus strictly involved in the management of

non-small lung cancer. An Analysis of early locoregional failures and toxicity. A. Gramaglia. F. Milani, S. Basso Ricci, S. Villa, A.V. Bedini, G. Ravasi. Istituto Nazionale Tumori, Milsno - Italy.

90 patients undergone RT (accrual period January 1987, December 1989) were evaluated according to their field converage. 45 patients (A Arm) were irradiated with wide fields encompassing the tumor with 2 cm lateral margin and 3 cm inferior margin both hila, mediastinum and supraclavicular limph-nodes even if uninvolved; 45 (B Arm) homolateral hilum mediastinal disease and tumor with same margins. 80 patients were evaluable with a minimum follow-up of 16 months (44 A and 36 B). No statistical difference Was scored in terms of

locoregional failure for adenocarcinoma while a trend has been noted in favour of an improved locoregional control in Arm A. No statistical difference regarding to fibrosis in both arms (3 patients each arm). Only transient esophagitis was more frequent using wide fields.

364

LONGER SURVIVAL UITH HIGHER DOSES OF THORACIC RADIOTHERAPY IN NON SMALL CELL LUNG CANCER (NSCLC)

Bell D, Matthews J, Uorotniuk V, Creman E Peter MacCaltun Cancer Institute (PIICI), Relbwrne, Australia E Crennen Peter HacCallun Cancer Institute, 481 Little Lonsdale St, Melbourne An analysis of the PHCI database of Lung center patients presenting during 1984 - 1989 inclusive has bee" performed to determine if e policy of high dose thorecic radiotherapy in previowly untreated patients with NSCLC is justified. 941 such patients with no evidence of disease beyond the primary site/mediastinun were analysed according to radiation treatment intention. As et 1.1.91. 61 patients (6.5%) were stiLL alive and 876 (93.0%) were deed. Five petimts (0.5%) were untraced. 893 (95%) felL into 4 defined groqx of plsmed dose schedules.

Intended No of fractions Patients Median survivat total dose (Gy) (InoS)

20 5 422 6.0 30 10 90 7.1 36 12 170 10.2 60 30 211 14.5

The increase in survive1 duration with the higher dose schedules YBS highly significant (pwO.0001). CM's regressim anelysis YBS performed on e Mlnber of possible progtwstic factors recorded et the time of presentation et PNCI. Performence status and weight loss had the most significant influence on survival. After edjustiw for the effects of these factors, the increased survive1 durations uith the higher dose sche&les were stilt highly significant. The relative death rates for patients in the 30 Gy, 36 Gy end 60 Gy groups were 941, 7% and 53% respectively of the death rete for patients in the 20 Gy group, adjusting for performance stetus and weight Loss. The dete support the hypothesis that the longer survival uith higher dose radiotherapy in patients with NSCLC is fwt due purely t0 patient rlecticn.