Lung Cancer.pdf

146 R. Komaki
and 26 patients had clinical stage T2N0 NSCLC. The median total dose of
radiation was 63 Gy, and 80% of the patients received doses higher than 60
Gy. Responses were documented with chest radiography, and in 60% of
the patients, the maximum response was seen within 6 months after completion
of radiation therapy. The median follow-up time was 36 months.
Disease-specific survival rates at 3 years were 49% for patients with T1
disease and 47% for patients with T2 disease. Local control rates at 3 years
were 89% for T1 lesions and 61% for T2 lesions (Figure 8–2). The significant
prognostic factors for better disease-free survival were Karnofsky
performance status score of 70 or higher, tumor size of 5 cm or smaller,
and radiation therapy dose of 50 Gy or greater. The significant prognostic
factors for better local control were tumor size of 4 cm or less, radiation
therapy dose of 60 Gy or greater, and complete response according to
chest radiography within 6 months after completion of radiation therapy.
Coverage of the nodal drainage area with elective radiation therapy did
not affect survival or local control. No lethal complications were seen, and
documented symptomatic radiation pneumonitis occurred in only 7% of
the patients (Kupelian et al, 1996).
At M.D. Anderson, we usually treat stage I tumors with 66 Gy delivered
at 2 Gy per fraction 5 days per week without inhomogeneity correction.
Figure 8–2. Overall survival, disease-specific survival, and local control rates for
45 patients with clinical stage I NSCLC treated with radiation therapy alone.
Reprinted from International Journal of Radiation Oncology Biology and Physics, volume
36, number 3, Kupelian PA, Komaki R, Allen P, Prognostic factors in the treatment
of node-negative non-small cell lung carcinoma with radiotherapy alone,
pages 607–613, 1996, with permission from Elsevier Science.