Proceedings of the 33rd Annual ASTRO Meeting 135

Materials and Methods: 143 pts treated for MI0 NSCLC between 1985 and 1990 were identified. Reasons for inoperability were poor pLllmonary reserve (62%), severe cardiac disease (ll%), cardiopulmonary disease ('3%) and prior contralateral lung surgery (6%).

multiple medical problems (12%)

used and initial curative intent was documented in all pts. Modern megavoltage RT techniques were

varying according to pulmonary reserve. The median tumor dose was 64.8 gray, with fields

No patient received chemotherapy.

Results: A preliminary analysis has been carried out. Overall survival , progression-free survival, and failure patterns were analyzed. The median overall actuarial survival and median progression-free survival for the entire group of pts were 19 and 17 months, respectively. at five years.

Survival probability was 36% at three years and 14% Survival and progression-free survival were correlated with tumor size. Pts with small and

intermediate size tumors experienced an increased survival compared to pts with larger tumors (pc.05). This is illustrated in the table.

TABLE - SURVIVAL BY TUMOR SIZE

Progression-Free Survival

Tumor Size

<= 3 cm. 3 - 6 cm. > 6 cm.

Median Overall Survival (Mos.~

36 22 10

24 month Probability

74 :63 .22

36 Month Probabilitv

.59

.49

.oo

Approximately 50% of failures were due to local progression. with tumors less than 3 cm..

Local recurrences were identified in 17% of pts 32% of pts with tumors of 3 - 6 cm.,

than 6 cm. and in 45% of those pts with tumors larger

Conclusion: series.

Results with small and intermediate size tumors are encouraging and comparable with surgical Local failure analysis suggests that increases in local control might result in improvement in overall

and progression-free survival. The implications of this study and the possibilities of "newer" fractionation schedules (hyperfractiona-tion) and "novel" be explored and analyzed in this context.

radiation therapy techniques (endobronchial "boost" implants) will

41 PREOPERATIVE ACCELERATED RADIOTHERAPY AND CONCURRENT CHEMOTHERAPY FOR STAGE IIIA (N2) NON-SMALL CELL LUNG CARCINOMA

NOAH C. CHOI, M.D.** DOUGLAS MATHISEN, M.D.*> ALAN HILGENBERG, M.D.*, ROBERT W CAREY, M.D.+? JOHN WAlN,

M.D. ++, and HERMES GRILLO, M.D.++, DEPARTMENTS OF RADIATION MEDICINE *, SURGERY ++, and MEDICINE +, MASSACHUSETTS GENERAL HOSPITAL, HARVARD MEDICAL SCHOOL, BOSTON, MA 02114

A phase 11 study was initiated in uur institution in 1988 to investigate a combined modality program of preoperative concurrent accelerated radiotherapy (RT) and chemotherapy (CT) followed by surgery (day 56), and then an additional cycle of CT and accelerated RT (day 85) for marginally resectable stage 1llA (N2) non-small cell lung carcinoma (NSCLC). CT comisted of Cisplatin 100 mg/m2 days 1 & 29, Velban 3 mg/m2 days 1 & 3, and 29 & 31, and S-FU 30 mgfkg/day by continuous infusion days l-3 and 29-31. Preoperative accelerated RT delivered a total dose of 42 Gy in 1.5 Gy bid, 5 days per week for 7 days for 21 Gy, 10 day rest, and another 21 Gy in 7 days. Postoperative therapies delivered another cycle of CT and 15-18 Gy of radiation by a 1.5 Gy bid schedule to the bronchial stump and involved region of the mediastinum. The target volume for preoperative RT included the primary lesion, the ipsilateral hilum, and the mediastinum. The entry criteria included biopsy proven metastatic NSCLC involving ipsilateral low paratracheal and/or subcarinal lymph node (LN), performance status of 2 70 on Karnofsky scale and expected postoperative FeVl 2 1 liter. The study endpoints consisted of a) tumor response, b) complete resectability, c) survival, d) sustained control of local-regional disease and e) toxicities,

A total of 19 consecutive patients(pts) have been entered into this prospective study as of September 1990. The patient age ranged from 33 to 76 yrs ( median of 58 yrs ), and the sex ratio was 3:l for male to female. The tumor stages included TMZMO in 3, T2N2MO in 12, T3N2MO in 2, and T4N2MO in 2. Histologic types consisted of squamous cell carcinoma in 10, adenocarcinoma in 6, and large cell carcinoma in 3.

All 19 pts were able to tolerate the induction therapy and underwent a curative resection. Tumor response to the preoperative therapies at the primary site defined by pathologic examination was as follows: No tumor in l/19, residual necrotic or microscopic tumor in 5/19, and partial response in 13/19 patients . No residual tumor was detected at hilar LN in 9/19 pts. The previously documented mediastinal LN involvement by mediastinoscopy became negative in 18 of 19 pts. Ten of 19 pts were alive without recurrence ranging from 6 months (M) to 36 M. The median survival time (MST) was 24M and their actuarial survivals at 1, 2, and 3 years were 70%, 53% and 35% respectively. None showed local-regional recurrence. Toxicities included postoperative cardiac death in 1 (l/19 ), aspiration pneumonia in 1, pneumonia associated with marked leukopenia during induction therapies in 3 and marked dysphagia requiring IV hydration in 1 pt.

The results of this study, i.e., complete resectability in 19/19 pts (100%) , sustained control of local-regional disease in 19/19 pts (lOO%), MST of 24M, and 2 and 3 year actuarial survival rates of 53% and 35%. are very encouraging, and this has become a multiinstitutional cooperative study group protocol.