Definitive radiation therapy for medically inoperable patients with stage I and II non-small cell lung cancer

Hayakawa, Kazushige; Mitsuhashi, Norio; Saito, Yoshihiro; Nakayama, Yuko; Katano, Susumu; Furuta, Masaya; Sakurai, Hideyuki; Takahashi, Tetsuya; Niibe, Hideo

doi:10.1002/(sici)1520-6823(1996)4:4<165::aid-roi3>3.0.co;2-w

Cited by 17 publications

(48 citation statements)

References 22 publications

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“…18 A complete response rate of 60% was observed in patients receiving 72 Gy compared with 32% after 60 Gy, although survival was unchanged 18. Local failure ranged from 6% to 70% and was related to the dose given12 21 25 and to tumour stage19 20 36 39 or size31 (table5). In-field, local, or locoregional progression free survival at 3 years was 44–51% 10…”

Section: Resultsmentioning

confidence: 99%

“…16 18 31 38 For those with involved hilar nodes, 5 year survival ranged from 12% to 22% 2324 31Survival was unaffected by whether or not patients had had CT imaging performed as part of staging 1024 …”

Section: Resultsmentioning

confidence: 99%

“…13 16 17 24 28 31 The presence of comorbidity13 28 or weight loss19 28affected survival adversely. There were striking differences in outcome according to performance status.…”

Section: Resultsmentioning

confidence: 99%

“…1-a Updated series: patients from Noordijk (1988)9were included in Krol (1996),16 from Hayakawa (1992)26 in Hayakawa (1996),31 from Dosoretz (1992)36 and (1993)37 in Dosoretz (1996),38 and from King (1996)33 in Sibley (1998) 21 …”

Section: Methodsmentioning

confidence: 99%

“…Some patients reported in Hayakawa (1996)31 were included in a subset of elderly patients with stage I/IIA tumours reported by Furuta (1996) 30. Slotman (1984)13 and (1987)17 reported patients from overlapping time periods.…”

Section: Methodsmentioning

confidence: 99%

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Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review

Rowell

Williams

2001

Thorax

153

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Objectives-To determine the eVectiveness of radical radiotherapy in medically inoperable stage I/II non-small cell lung cancer (NSCLC) and the extent of treatment related morbidity. Methods-Randomised trials were sought by electronically searching the Cochrane Clinical Trials Register, and both randomised and non-randomised trials were sought by searching Medline and Excerpta Medica (Embase). Further studies were identified from references cited in those papers already identified by electronic searching. The studies included were those of patients of any age with stage I/II NSCLC receiving radiotherapy at a dose of >40 Gy in 20 fractions over 4 weeks or its radiobiological equivalent. Results-Two randomised and 35 nonrandomised studies were identified. One randomised and nine non-randomised studies did not meet the selection criteria, leaving one randomised and 26 nonrandomised studies for analysis. In the randomised trial 2 year survival was higher following continuous hyperfractionated accelerated radiotherapy (CHART; 37%) than following 60 Gy in 30 fractions over 6 weeks (24%). An estimated 2003 patients were included in the 26 non-randomised studies; overall survival was 22-72% at 2 years, 17-55% at 3 years, and 0-42% at 5 years. Following treatment, 11-43% of patients died from causes other than cancer. Cancer specific survival was 54-93% at 2 years, 22-56% at 3 years, and 13-39% at 5 years. Complete response rates were 33-61% and local failure rates were 6-70%. Distant metastases developed in approximately 25% of patients. Better response rates and survival were seen in those with smaller tumours and in those receiving higher doses although the reasons for prescribing higher doses were not clearly stated. The outcome was worse in those with prior weight loss or poor performance status. Assessment of treatment related morbidity and eVects on quality of life and symptom control were inconclusive because of the lack of prospective evaluation and paucity of data. Conclusions-No randomised trials compared a policy of immediate radical radiotherapy with palliative radiotherapy given when patients develop symptoms. In the absence of such trials, radical radiotherapy appears to result in a better survival than might be expected had treatment not been given. A substantial, though variable, proportion of patients died during follow up from causes other than cancer. The optimal radiation dose and treatment technique (particularly with respect to mediastinal irradiation) remain uncertain. (Thorax 2001;56:628-638)

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…13 16 17 24 28 31 The presence of comorbidity13 28 or weight loss19 28affected survival adversely. There were striking differences in outcome according to performance status.…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review

Rowell

Williams

2001

Thorax

153

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Extent of surgery and survival in early lung carcinoma

Sugarbaker

Strauss

2000

Cancer

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BACKGROUND With the advent of minimally invasive surgical techniques, a determination of the efficacy of limited resection in Stage IA nonsmall cell lung carcinoma (NSCLC) must be determined. The critical question is whether the probability of cure is equivalent with limited resection and with standard lobectomy. DATA ANALYSIS The results of three independent reports are analyzed. The only randomized trial is that of the Lung Cancer Study Group, in which 247 patients with peripheral Stage IA lesions were randomized to lobectomy or limited resection. The results indicate that recurrence rate and lung carcinoma mortality rates are higher among those undergoing limited resection. In another nonrandomized series, which involved 218 consecutive Stage IA patients, there was a significantly inferior survival rates among those undergoing limited resection compared with lobectomy. The third study is a retrospective analysis involving 244 Stage I patients treated at the Brigham and Women's Hospital (BWH). This trial shows that limited resection is inferior to anatomic resection in both Stage IA and Stage IB NSCLC. Indeed, the importance of complete resection is underscored by the finding that Stage IA patients undergoing limited resection were significantly less likely to be cured that Stage IB patients undergoing lobectomy. Accordingly, the BWH trial supports the conclusion that the extent of surgical resection is more powerful determinant of survival than natural history of disease in Stage I NSCLC. Cumulatively, the results of these three trials show that among patients with Stage I NSCLC, limited resection is inferior to lobectomy with regard to the probability of producing cure. CONCLUSIONS The finding that limited resection is inferior to lobectomy has relevance to the hypothesis that chest X‐ray screening may lead to the identification of clinically unimportant lung carcinomas, which have been termed pseudotumors. This hypothesis, known as overdiagnosis, is the only alternative to the conclusion from four existing randomized trials that chest X‐ray screening leads to an improvement in lung cancer cure rates. However, if extent of surgical resection is the major determinant of survival in Stage IA NSCLC, then these lesions must be clinically important. These findings support the conclusion that chest X‐ray screening does not lead to the detection of Stage IA pseudotumors of the lung. Accordingly, current public policy calling for no routine screening for the early detection of lung cancer must be reconsidered. Cancer 2000;89:2432–7. © 2000 American Cancer Society.

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Extent of surgery and survival in early lung carcinoma

Sugarbaker

Strauss²

2000

Cancer

View full text Add to dashboard Cite

The finding that limited resection is inferior to lobectomy has relevance to the hypothesis that chest X-ray screening may lead to the identification of clinically unimportant lung carcinomas, which have been termed pseudotumors. This hypothesis, known as overdiagnosis, is the only alternative to the conclusion from four existing randomized trials that chest X-ray screening leads to an improvement in lung cancer cure rates. However, if extent of surgical resection is the major determinant of survival in Stage IA NSCLC, then these lesions must be clinically important. These findings support the conclusion that chest X-ray screening does not lead to the detection of Stage IA pseudotumors of the lung. Accordingly, current public policy calling for no routine screening for the early detection of lung cancer must be reconsidered.

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Definitive radiation therapy for medically inoperable patients with stage I and II non-small cell lung cancer

Cited by 17 publications

References 22 publications

Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review

Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review

Extent of surgery and survival in early lung carcinoma

Extent of surgery and survival in early lung carcinoma

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