Sequelae of Radical Radiotherapy of Carcinoma of the Lung

Abstract

Although radiotherapy offers adequate palliation of symptoms in inoperable carcinoma of the lung, the overall cure rates have been disappointing (1–4). A recent study reported a high incidence of severe complications in long-term survivors of treatment (5). We were interested in the frequency of complications, both acute and late, in our patients following radical radiotherapy. This is of major importance because of the reports of Bleodorn et al. (6–8) and other workers (9, 10) concerning the possible advantage of combined radiotherapy and surgery in the management of carcinoma of the lung. If this combination therapy increases the survival rate of patients with carcinoma of the lung, more who receive radical radiotherapy will be exposed to long-term complications. Included also in this report are survival data of all patients and our preliminary observations on patients given radiation followed by surgery. Methods All 132 persons treated in our institution (Grace-New Haven Community Hospital) for primary carcinoma of the lung from September 1958 to December 1961 are included in this study. These patients were considered inoperable or were found at thoracotomy to have unresectable tumors. None with distant metastases when first examined were included in this study. All but 2 were treated with supervoltage radiation therapy, using a 2-Mev Van de Graaff generator. The other 2 patients were treated with 250 kv x-ray. Eight of the 132 patients had post-irradiation resections. No patients were lost to follow-up. Pathologic confirmation of the diagnosis was obtained in all but 8 patients. In these 8 there were emergency symptoms such as superior vena caval obstructive syndrome or all conventional methods of obtaining diagnosis short of thoracotomy were performed, and the patients were not considered candidates for thoracotomy. A second group of 24 patients treated from September 1958 to July 1963, who received radical supervoltage radiation therapy followed by thoracotomy in four to eight weeks, are considered separately. All results reported are calculated with the cumulative survival method (11). Patients were treated at least eighteen months before this evaluation, and, since none were lost to follow-up, the cumulative survival is the same as the actual survival for these months. The method of radiation therapy gradually evolved; however, the current technic is similar to that described by Bloedorn et al. (8). A tumor dose of 4,000 r in four weeks is delivered through opposing portals to the primary tumor and mediastinum. The area treated is then reduced to the primary and immediately draining hilar nodes, and is given 1,500 to 2,000 r in one-and-a-half to two weeks, for a total tumor dose of 5,500 to 6,000 r in five-and-a-half to six weeks. With these reduced portals care was taken to restrict the spinal cord dose. Most patients received less than 5,000 r and few received in excess of 5,400 r in six weeks to the spinal cord.