The Curative Treatment by Radiotherapy Alone of Stage I Non-Small Cell Carcinoma of the Lung

doi:10.1378/chest.108.5.1278

Chest

Volume 108, Issue 5, November 1995, Pages 1278-1282

https://doi.org/10.1378/chest.108.5.1278 Get rights and content

This review was initiated to assess the outcome of treatment with radical radiotherapy with curative intent for patients diagnosed as having stage I non-small cell lung cancer. The study involved a retrospective review of 347 patients with T1 and T2N0M0 tumors treated at the Queensland Radium Institute during the period 1985 to 1992. The main reasons for not proceeding to surgery included poor performance status, old age, or refusal to submit to surgery. The median age for the group was 70 years, with the range being 34 to 90 years. Patients in this group were all treated by a standard technique involving external-beam radiotherapy to 50 Gy, minimum tumor dose, in 20 fractions over 4 weeks. The overall survival rate was 27% at 5 years with a median survival of 27.9 months. The 5-year recurrence-free survival was 23% with the median being 19.5 months. There was a strong correlation of survival to tumor size with 5-year survival rates being 32% and 21% for T1 and T2 tumors, respectively. Multivariate analysis found only T stage to be associated with overall survival (p<0.01). In addition, the analysis showed that age younger than 70 years was a prognostic factor that approached statistical significance at the p<0.05 level of significance. We conclude from this large series of patients with stage I non-small cell lung cancer that radical radiotherapy with curative intent may be a viable alternative to surgery in those patients who either refuse surgery or are judged to be unfit for operation.

Section snippets

Materials and Methods

In November 1994, a retrospective review involving the examination of records of lung cancer patients treated at the Queensland Radium Institute (QRI) in the period from January 1985 to June 1992 was performed. A total of 347 patients with clinical stage I disease were identified. Inclusion criteria required the patients to have a pathologic diagnosis of non-small cell lung cancer, be staged as either T1 or T2N0M0 in accordance with the International Union Against Cancer (UICC) system, and

Results

The overall survival for all patients was 54% at 2 years, 40% at 3 years, and 27% at 5 years, with a median survival of 27.9 months (Fig 1). Figure 2 outlines the recurrence-free survival for the group. This was 41% at 2 years, 32% at 3 years, and 23% at 5 years with a median recurrence-free survival of 19.5 months.

Figures 3 and 4 confirm the significance of T stage as an important factor in determining both survival and recurrence-free survival. When the group was divided into T1 and T2

Discussion

Despite the continuing efforts of both clinicians and researchers, non-small cell lung cancer continues to be associated with an overall poor prognosis. However, significantly improved outcomes can be anticipated in certain subsets in this malignancy, particularly in those patients with early-stage disease. Accordingly, a nihilistic approach to treatment may not be appropriate in all cases.

In the case of technically operable early-stage non-small cell carcinoma of the lung, surgical resection

Acknowledgments

We are indebted to the Director, Queensland Radium Institute, for allowing us to publish this study and to his staff for their assistance in the preparation of the manuscript.

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Lung cancer is the second most diagnosed cancer and the leading cause of cancer-related mortality in Canada. Surgical resection is the treatment of choice for patients with stage I non–small-cell lung cancer (NSCLC). However, 20% to 30% of them are deemed medically inoperable and may be offered radiation therapy. Standard external-beam radiation therapy (EBRT) is associated with high rates of local recurrence and poor long-term survival. Stereotactic ablative radiation therapy (SABR) is increasingly being proposed for inoperable patients, and the use of this treatment modality for operable patients is also being contemplated. The objective of this guideline is to review the efficacy and safety of SABR in these two clinical situations and to develop evidence-based recommendations.
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Clinical Investigations: Lung CancerThe Curative Treatment by Radiotherapy Alone of Stage I Non-Small Cell Carcinoma of the Lung

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiother Oncol

Int J Radiat Oncol Biol Phy

Int J Radiat Oncol Biol Phys

Chest

Ann Thorac Surg

Lancet

Clin Oncol

Clinical Investigations: Lung Cancer
The Curative Treatment by Radiotherapy Alone of Stage I Non-Small Cell Carcinoma of the Lung