Improved survival of patients with unresectable non-small-cell bronchogenic carcinoma by an innovated high-doseEn-Bloc radiotherapeutic approach

Abstract

From 1972 to 1977, 162 patients were treated with definitive radiotherapy for the underlying unresectable non‐small‐cell bronchogenic carcinoma by a radiotherapeutic technique that had sequentially evolved from a low‐dose (40–45 gray) small‐volume approach (AP‐PA POP) to a high‐dose (60–64 gray) large‐volume en‐bloc approach (AP‐PA POP plus AP‐RPO‐LPO) which included the primary tumor and the entire regional lymphatics including both supraclavicular areas. Median survival and short‐term survival up to 1.5 years were independent of radiation doses (40–64 gray) and target volumes studies. However, long‐term survival ⩾ 2 years was radiation‐dose and target‐volume dependent: actuarial survival 36% and 28% vs. 10% and 3% for the high‐dose (60–64 gray) en‐bloc approach vs. Low‐dose (40–45 gray) small‐volume radiotherapy at 2 and 3 years, respectively, with a minimum follow‐up of 2 years, P < 0.05. Actuarial five‐year survival rate 7.5% was obtained with radiation dose ⩾ 50 gray. However, there was no five‐year survivor among patients who were treated with radiation dose < 50 gray. Local tumor control is radiation‐dose dependent: local tumor control rates at ⩾ 18 months were 76% vs. 29% by 56–64 gray vs. 40–49 gray, respectively, P < 0.05. The patterns of failure appeared to be tumor‐histology dependent; for squamous cell carcinoma, the primary and regional lymphatic areas are the most common sites of failure, and for adenocarcinoma, it is the brain or bone. The high‐dose en‐bloc radiotherapy has been very well tolerated; 5% (4/80) incidence of symptomatic pneumonitis has been observed.