Japanese Journal of Clinical Oncology 31:55-60 (2001)
© 2001 Foundation for Promotion of Cancer Research
Intra-thoracic Failure Pattern and Survival Status Following 3D Conformal Radiotherapy for Non-small Cell Lung Cancer: a Preliminary Report
1Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 2Department of Oncology, National Taiwan University Hospital, Taipei and 3Department of Radiation Therapy and Oncology, China Medical College Hospital, Taichung, Taiwan
Background: To study the intra-thoracic failure pattern, clinical target volume (CTV) and survival status following 3D conformal radiotherapy (3DCRT) boost for non-small cell lung cancer (NSCLC).
Methods: From May 1994 through June 1998, 33 patients (26 male, seven female) with NSCLC were treated with a complete course of radiotherapy (RT) in our institute. Group A included 10 patients receiving radical operation and adjuvant postoperative RT. The other 23 patients (groups B and C) received definitive radiotherapy as local treatment. Among them there were seven cases as group B (stage I–II) and 16 cases as group C (stage III). Fifteen (15/33) patients received chemotherapy. The radiotherapy strategy constituted conventional AP/PA radiotherapy (RT) 19.8–45 Gy (median 39.6 Gy) plus 3DCRT boost 6–34.2 Gy (median 20 Gy). The median total tumor dose was 59.6 Gy (ranging from 39.8 to 64.8 Gy). Patients were followed up regularly (6/33) or until their death (27/33). Nineteen patients received follow-up chest computed tomography (CT). The relationship between intra-thoracic failure found by chest CT and the initial RT and boost RT fields was analyzed. Local failure was defined as one of the following: clinical disease progression, CXR progression or relapse noted by CT. The overall survival (OS) and local failure free survival (LFF) were obtained using the Kaplan–Meier method.
Results: Sixteen intra-thoracic failures were noted in 15 follow-up chest CT examinations, which included nine in-field relapses, three partial in-field relapses and four out-field relapses. The 2-year OS and LFF for groups A, B and C were 78.8/59.2, 14.2/16.7 and 6.2/7.1% respectively. RTOG grade III/IV complications included one pneumothorax (RTOG grade III).
Conclusion: Our retrospective study showed that selective omission of contralateral mediastinal lymph node station irradiation may be appropriate in RT for NSCLC. Chest wall and pleural relapses may not be a negligible cause of intra-thoracic failure after RT for NSCLC.
+ For reprints and all correspondence: Fang-Jen Lin, Department of Radiation Therapy and Oncology, Shin Kong Memorial Hospital, 95 Wen Chang Road, Shi-Lin, Taipei, Taiwan. E-mail: a0080@ms2.hinet.net
Abbreviations: 3D, three-dimensional; 3DCRT, 3D conformal radiotherapy; AC, adenocarcinoma; ATS, American Thoracic Society; BTV, biological target volume; CCRT, concurrent chemo-radiotherapy; CPE, contralateral malignant pleural effusion; CT, computed tomography; C/T, chemotherapy; CTV, clinical target volume; CTV1, tumor site/risky tumor bed, ipsilateral hilum, whole mediastinum and bilateral SCF when indicated; CTV2, tumor site or risky tumor bed with/without ENI; CTV-N CTV of risky lymphatics; CTV-T, CTV of peri-tumor region; CXR, chest X-ray; CW, chest wall relapses; EBRT, external beam RT; ENI, elective nodal irradiation; ILN, ipsilateral mediastinum LN; IPE, ipsilateral malignant pleural effusion; LFF, local failure free; LRR-CT, local-regional failure diagnosed by CT; NS, non-specified; NSCLC, non-small cell lung cancer; OS, overall survival; OP, operated; PN, pleural nodular relapses; PTV, planned target volume; RO, radiation oncologist; RT, radiotherapy; RTOG, Radiation Therapy Oncology Group; SCC, squamous cell carcinoma; SCF, supraclavicle fossa; TS, tumor site/bed