Definitive radiotherapy with or without chemotherapy for clinical stage T4N0-1 non-small cell lung cancer

PURPOSE: To determine failure patterns and survival outcomes of T4N0-1 non-small cell lung cancer (NSCLC) treated with definitive radiotherapy. MATERIALS AND METHODS: Ninety-five patients with T4N0-1 NSCLC who received definitive radiotherapy with or without chemotherapy from May 2003 to October 2014 were retrospectively reviewed. The standard radiotherapy scheme was 66 Gy in 30 fractions. The main concurrent chemotherapy regimen was 50 mg/m2 weekly paclitaxel combined with 20 mg/m2 cisplatin or AUC 2 carboplatin. The primary outcome was overall survival (OS). Secondary outcomes were failure patterns and toxicities. RESULTS: The median age was 64 years (range, 34 to 90 years). Eighty-eight percent of patients (n = 84) had an Eastern Cooperative Oncology Group performance status of 0-1, and 42% (n = 40) experienced pretreatment weight loss. Sixty percent of patients (n = 57) had no metastatic regional lymph nodes. The median radiation dose was EQD2 67.1 Gy (range, 56.9 to 83.3 Gy). Seventy-one patients (75%) were treated with concurrent chemotherapy; of these, 13 were also administered neoadjuvant chemotherapy. At a median follow-up of 21 months (range, 1 to 102 months), 3-year OS was 44%. The 3-year cumulative incidences of local recurrence and distant recurrence were 48.8% and 36.3%, respectively. Pretreatment weight loss and combined chemotherapy were significant factors for OS. Acute esophagitis over grade 3 occurred in three patients and grade 3 chronic esophagitis occurred in one patient. There was no grade 3-4 radiation pneumonitis. CONCLUSION: Definitive radiotherapy for T4N0-1 NSCLC results in favorable survival with acceptable toxicity rates. Local recurrence is the major recurrence pattern. Intensity modulated radiotherapy and radio-sensitizing agents would be needed to improve local tumor control.

Clinical Analysis of Gamma Knife Radiosurgery for Brain Metastases

Brain metastases from systemic cancer remains a significant source of morbidity and mortality. The clinical results of gamma knife radiosurgery for brain metastases are analyzed to identify treatment parameters and ascertain effectiveness correlated with local tumor control. Between May 1990 and August 1993, 103 patients with brain metastases were treated with gamma knife radiosurgery. Forty four patients had single metastasis. But the rest of the patients had multiple brain metastases: two lesions in 22 patients, three lesions in 13 patients, and more than four lesions in 24 patients. They were expected to survive more than three months and their Karnofsky performance scores were 70% or more. Fifty nine patients underwent radiosurgery only. Seventeen patients had received adjuvant whole brain radiotherapy(WBRT) with radiosurgery. Among 27 patients who underwent tumor resection and radiosurgery, 10 patients had received combined WBRT also. Despite of 91.6% of local tumor control, overall median survival was 9 months. Local recurrence rate was 8% but 30% of the patients were proved to distant recurrence. Combined radiotherapy and radiosurgery are not documented to improve local tumor control and survival. Gamma knife radiosurgery is shown to be effective and safe in controlling brain metastases. Further investigation is necessary to define optimal treatment parameters for radiosurgery.