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517 135 518 EXTERNAL RE-IRRADIATION OF NON SMALL CELL LUNG CANCER (NSCLC); A PILOT STUDY. G.W. Kramer’. S.J. Gans’, E.F. Ullmann’. Radiotherapeutic Institute Arnhem’ , Rijnslatc Hospital. Arnhem’, St. Jan&l Hospilal. Hardcrwijk’, The Netherlands. Fourteen patients with recurrent NSCLC after 45 - 60 Gy radiotherapy,were re- irradiated palliatively with 2 large smgle doses of 8 Gy at day 1 and 8. Treament was delivered with 2 opposed 6-18 MV photonfields encompassing all tlrmor rccw+en&es visible at bronchoxopy and/or thorax-CT. The myelum was kept outside the treatment fields. Recurrent NSCLC was confnmed histologically in all patients, except in those having superior vena cava syndrome (VCS). P&al (PR) and Complete Relieve (CR) of the complaints were scored, as illustrated in the Table below. COMPlAINTS N PR+CR DURATION MEDIAN (%) (mo) (mo) vcs 4 loo 15 2-12 5 Dyspnoea 9 45 35 4.19 8 Hemopioe 8 IM loo l-14 7 OVeI”ll 21 80 70 1-19 7 Complete Relieve (CR) was achieved in 70% of the complaints. particularly in patients with VCS and hemoptoe. Median duration of CR was 7 months. Treatment was tolerated well. Medical s”pport for pnenmonitis was necessary in 2 patients. Six patients died sofar, of which 5 succumbed because of recurrent intrathomcic disease. Fromibis pilot study we conclude that exlemal beam re-inadiition in this form can be a good optim for palliative care in NSCL.C. 519 EXAMINATION OF AUTOPSY CASES OF LUNG CANCER. IS IT POSSIBLE TO CONTROL THE PRIMARY SITE OF NON-SMALL CELL LUNG CANCER BY RADIOTHERAPY? Y. Nakayama, K. Hayakawa, Y. Saito, M. Nozaki, M. Takahasi, I. Hashida, M. Kawashima, N. Mitsuhashi, T. Nakajima, H. Niibe. Gunma University School of Medicine, Maebashi, Gunma, Japan. It is difficult to diagnose clinically local control of lung cancer treated with radiotherapy due to radiation fibrosis. Therefore, we examined autopsy cases histologically to clarify the possibility of radiotherapy to control the primary site of lung cancer. Among patients with non-small cell lung cancer treated with radiotherapy during 1976-1991, 95 patients who underwent autopsy were evaluated. Among them, 58 patients were irradiated radically with a dose of 6OGy or over (A group). Thirteen patients were irradiated with a dose of over 50Gy but less than 60GY (B group), and 24 patients with less than 5OGy (C group). The local control rate of A group patients was 33% (20/58). Eleven patients had complete disappearance of tumor. 9 patients had a small amount of degenerated cancer cells or nests at the primary site of the lung cancer. In B group, there was a case with poorly differentiated adenocarcinoma which was irradiated with 54Gy and was free of tumor. In C group, only one case with epidermoid carcinoma who died immediately after completion of irradiation at 44Gy was tumor free. This result is good in spite of autopsy cases, and suggests that the optimal irradiated dose should be 60Gy or over. CENTRAL AIRWAY OBST,RUCTIONS: PALLIATION WITH Nd-YAG LASER. Mereu C.‘ , Verna A.‘ , Ratto G.B.“, Tassara E ‘ , Nlcosia F.A, Zappi L.“, Mignone L.“. Carossino D.A ‘1st. di Oncologia Clinica e Sperimentale - Universita di Genova, ltalia “Cattedra di Chirurgia Toracica - Universita di Genova. ltalia “Servizio di Anestesia e Rianimazione - IST. Genova, Italia. In the last 3 years we treated 215 patients with non resectable major airway obstructions and dispnoea, hemoptysis or post-stenotic infections. Indications were benign lesions in 35 patients (post-intubation tracheal stenosis or malacia, post-surgical bronchial stenosis, granuloma. benign or carcinoid tumors) and malignant lesions in 160 patients (bronchogenic carcinoma or metastases of extra-lung tumors). Laser treatments with neodimium-yttrium-alummium-garnet (Nd- YAG) laser were performed, usually, after mechanical dilatation with a rigid bronchoscope and under general anesthesia. In 20 cases we repeated laser treatment after l-6 months, because of malignant reobstruction. In 40 oases we placed a tracheobronchial stent and in 58 cases we planned chemotherapy, radiotherapy or brachitherapy. All treatments were well tolerated. We observed hypoxia in 45 patients during the procedure and 1 fatal post-treatment bleeding, probably related to local necrosis of advanced tumor. For the same benign tumors and for post-intubation or post- surgical stenosis the laser procedure has proved to be a curative treatment and may avoid thoracotomy. For malignant tumors the laser procedure is an effective, immediate and safe therapy, but long term results depend on many factors: histology, extent of involvement, overall status of the patients and indication to other palliative therapy. 520 RADIATION THERAPY FOR THE ELDERLY WITHNON-SMALL CELL LUNG CANCER S.Katano, K.Hayakawa, Y.Saito, O.Mitano, I.Takahashi, Y.Tamaki, J.Honjo, K.Ishizeki, N.Mitsuhashi, H.Niibe. Department of Radiology and Radiation Oncology, GunmaUniversity Schoolof Medicine, Maehashi, Gunma,Japan The incidence of the elderly has recently increased in Japan. Therefore, retrospective analysis was performed to investigate the outcane of radiation therapy for the elderly with non-small cell lung cancer treated with definitive radiation therapy delivering doses in excess of SOGy between 1976 and 1985. The treatment resuls for 70 patients '75 years of age or older (ElderlyGroup) were evaluated,comparedwith those for 155 patients younger than 75 year old (Younger Group). Sixty patients in elderly Group were male. Fifty-six patients had epidermoid carcinoma and 14 had adenocarcinoma. The distribution of clinical stage was as follows: 28 had Stage I or II disease and the remainder had Stage m disease. There was not a significant difference between two groups in the distribution of stage or histological type. All patients were treated with 10 MV X-rays using conventional fractionation of 2 GY. The P-year and S-year survival rates for Elderly Group were 29% and 12%, respectively, while the corresponding rates for Younger Group were 34% and 14%. The survival rates for Elderly Group were the same as those for Younger Group. No severe late complication associated with radiation therapy was oberved except for mild acceptable acute one in this series. As a results, we now recommend that radiation therapy be given to the elderly 15 years of age or older as an acceptable choice of treatment.

Examination of autopsy cases of lung cancer. Is it possible to control the primary site of non-small cell lung cancer by radiotherapy?

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518

EXTERNAL RE-IRRADIATION OF NON SMALL CELL LUNG CANCER (NSCLC); A PILOT STUDY. G.W. Kramer’. S.J. Gans’, E.F. Ullmann’. Radiotherapeutic Institute Arnhem’, Rijnslatc Hospital. Arnhem’, St. Jan&l Hospilal. Hardcrwijk’, The Netherlands.

Fourteen patients with recurrent NSCLC after 45 - 60 Gy radiotherapy, were re- irradiated palliatively with 2 large smgle doses of 8 Gy at day 1 and 8. Treament was delivered with 2 opposed 6-18 MV photonfields encompassing all tlrmor rccw+en&es visible at bronchoxopy and/or thorax-CT. The myelum was kept outside the treatment fields. Recurrent NSCLC was confnmed histologically in all patients, except in those having superior vena cava syndrome (VCS). P&al (PR) and Complete Relieve (CR) of the complaints were scored, as illustrated in the Table below.

COMPlAINTS N PR+CR DURATION MEDIAN

(%) (mo) (mo)

vcs 4 loo 15 2-12 5

Dyspnoea 9 45 35 4.19 8

Hemopioe 8 IM loo l-14 7

OVeI”ll 21 80 70 1-19 7

Complete Relieve (CR) was achieved in 70% of the complaints. particularly in patients with VCS and hemoptoe. Median duration of CR was 7 months. Treatment was tolerated well. Medical s”pport for pnenmonitis was necessary in 2 patients. Six patients died sofar, of which 5 succumbed because of recurrent intrathomcic disease. From ibis pilot study we conclude that exlemal beam re-inadiition in this form

can be a good optim for palliative care in NSCL.C.

519

EXAMINATION OF AUTOPSY CASES OF LUNG CANCER. IS IT POSSIBLE TO CONTROL THE PRIMARY SITE OF NON-SMALL CELL LUNG CANCER BY RADIOTHERAPY? Y. Nakayama, K. Hayakawa, Y. Saito, M. Nozaki, M. Takahasi, I. Hashida, M. Kawashima, N. Mitsuhashi, T. Nakajima, H. Niibe. Gunma University School of Medicine, Maebashi, Gunma, Japan. It is difficult to diagnose clinically local

control of lung cancer treated with radiotherapy due to radiation fibrosis. Therefore, we examined autopsy cases histologically to clarify the possibility of radiotherapy to control the primary site of lung cancer. Among patients with non-small cell lung cancer treated with radiotherapy during 1976-1991, 95 patients who underwent autopsy were evaluated. Among them, 58 patients were irradiated radically with a dose of 6OGy or over (A group). Thirteen patients were irradiated with a dose of over 50Gy but less than 60GY (B group), and 24 patients with less than 5OGy (C group). The local control rate of A group patients was

33% (20/58). Eleven patients had complete disappearance of tumor. 9 patients had a small amount of degenerated cancer cells or nests at the primary site of the lung cancer. In B group, there was a case with poorly differentiated adenocarcinoma which was irradiated with 54Gy and was free of tumor. In C group, only one case with epidermoid carcinoma who died immediately after completion of irradiation at 44Gy was tumor free. This result is good in spite of autopsy cases,

and suggests that the optimal irradiated dose should be 60Gy or over.

CENTRAL AIRWAY OBST,RUCTIONS: PALLIATION WITH Nd-YAG LASER.

Mereu C.‘, Verna A.‘, Ratto G.B.“, Tassara E ‘, Nlcosia F.A, Zappi L.“, Mignone L.“. Carossino D.A ‘1st. di Oncologia Clinica e Sperimentale - Universita di Genova, ltalia “Cattedra di Chirurgia Toracica - Universita di Genova. ltalia “Servizio di Anestesia e Rianimazione - IST. Genova, Italia.

In the last 3 years we treated 215 patients with non resectable major airway obstructions and dispnoea, hemoptysis or post-stenotic infections.

Indications were benign lesions in 35 patients (post-intubation tracheal stenosis or malacia, post-surgical bronchial stenosis, granuloma. benign or carcinoid tumors) and malignant lesions in 160 patients (bronchogenic carcinoma or metastases of extra-lung tumors).

Laser treatments with neodimium-yttrium-alummium-garnet (Nd- YAG) laser were performed, usually, after mechanical dilatation with a rigid bronchoscope and under general anesthesia.

In 20 cases we repeated laser treatment after l-6 months, because of malignant reobstruction. In 40 oases we placed a tracheobronchial stent and in 58 cases we planned chemotherapy, radiotherapy or brachitherapy.

All treatments were well tolerated. We observed hypoxia in 45 patients during the procedure and 1 fatal post-treatment bleeding, probably related to local necrosis of advanced tumor.

For the same benign tumors and for post-intubation or post- surgical stenosis the laser procedure has proved to be a curative treatment and may avoid thoracotomy. For malignant tumors the laser procedure is an effective, immediate and safe therapy, but long term results depend on many factors: histology, extent of involvement, overall status of the patients and indication to other palliative therapy.

520

RADIATION THERAPY FOR THE ELDERLY WITH NON-SMALL CELL LUNG CANCER S.Katano, K.Hayakawa, Y.Saito, O.Mitano, I.Takahashi, Y.Tamaki, J.Honjo, K.Ishizeki, N.Mitsuhashi, H.Niibe. Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Maehashi, Gunma, Japan The incidence of the elderly has recently increased in Japan.

Therefore, retrospective analysis was performed to investigate the outcane of radiation therapy for the elderly with non-small cell lung cancer treated with definitive radiation therapy delivering doses in excess of SOGy between 1976 and 1985. The treatment resuls for 70 patients '75 years of age or older (Elderly Group) were evaluated, compared with those for 155 patients younger than 75 year old (Younger Group). Sixty patients in elderly Group were male. Fifty-six patients had epidermoid carcinoma and 14 had adenocarcinoma. The distribution of clinical stage was as follows: 28 had Stage I or II disease and the remainder had Stage m disease. There was not a significant difference between two groups in the distribution of stage or histological type. All patients were treated with 10 MV X-rays using conventional fractionation of 2 GY.

The P-year and S-year survival rates for Elderly Group were 29% and 12%, respectively, while the corresponding rates for Younger Group were 34% and 14%. The survival rates for Elderly Group were the same as those for Younger Group. No severe late complication associated with radiation therapy was oberved except for mild acceptable acute one in this series.

As a results, we now recommend that radiation therapy be given to the elderly 15 years of age or older as an acceptable choice of treatment.