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Inoperable localized stage I and stage II non-small-cell lung cancer

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Opinion statement

Early stage, medically inoperable non-small-cell lung cancer is a treatable disease. A thorough clinical work-up is necessary to optimize management for this group of patients. Thoracic radiation therapy has been used for such patients with achievement of durable local control and prolonged survival. To improve upon the results of standard fractionation radiation therapy, novel approaches are needed. Dose escalation may further enhance local tumor control and survival rates. Efforts to minimize irradiation to normal lung parenchyma are necessary. Multiple strategies to optimize the therapeutic ratio are being investigated. Elimination of elective nodal irradiation may reduce late toxicity of treatment but may compromise locoregional control. Other strategies, such as intensity-modulated radiation therapy with dose volume histograms will help minimize lung parenchyma irradiation, which will reduce the probability of radiation pneumonitis. Chemotherapy appears to play a minimal role in the treatment of inoperable limited disease, but researchers continue to conduct investigational trials with active chemotherapeutic agents in the hopes of reducing local and distant tumor failures.

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References and Recommended Reading

  1. Mountain CF: Revisions in the International System for Staging Lung Cancer. Chest 1997, 111:1710–1717. An excellent review of the current American Joint Committee on Cancer 1997 staging system with survival data for each stage of lung cancer.

    PubMed  CAS  Google Scholar 

  2. Sandler HM, Curran WJ Jr, Turrisi AT III: The influence of tumor size and pretreatment staging on outcome following radiation therapy alone for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 1990, 19:9–13.

    PubMed  CAS  Google Scholar 

  3. Takizawa T, Terashima M, Koike T, et al.: Lymph node metastasis in small peripheral adenocarcinoma of the lung. J Thorac Cardiovasc Surg 1998, 116:276–280.

    Article  PubMed  CAS  Google Scholar 

  4. Maruyama R, Sugio K, Mitsudomi T, et al.: Relationship between early recurrence and micrometastases in the lymph nodes of patients with stage I non-small-cell lung cancer. J Thorac Cardiovasc Surg 1997, 114:535–543.

    Article  PubMed  CAS  Google Scholar 

  5. Gupta NC, Graeber GM, Rogers JS, et al.: Comparative efficacy of positron emission tomography with FDG and computed tomographic scanning in preoperative staging of non-small-cell lung cancer. Ann Surg 1999, 229:286–291.

    Article  PubMed  CAS  Google Scholar 

  6. Farrell MA, McAdams HP, Herndon JE, et al.: Non-smallcell lung cancer: FDG PET for nodal staging in patients with stage I disease. Radiology 2000, 215:886–890.

    PubMed  CAS  Google Scholar 

  7. Weder W, Schmid RA, Bruchhaus H, et al.: Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg 1998, 66:886–892.

    Article  PubMed  CAS  Google Scholar 

  8. Passlick B, Kubuschok B, Izbicki JR, et al.: Isolated tumor cells in bone marrow predict reduced survival in node-negative non-small-cell lung cancer. Ann Thorac Surg 1999, 68:2053–2058.

    Article  PubMed  CAS  Google Scholar 

  9. Walsh GL, Pisters KM, Stevens C: Treatment of stage I lung cancer. Chest Surg Clin North Am 2001, 11:17–38.

    CAS  Google Scholar 

  10. Gauden SJ, Tripcony L: The curative treatment by radiation therapy alone of stage I non-small-cell lung cancer in a geriatric population. Lung Cancer 2001, 32:71–79.

    Article  PubMed  CAS  Google Scholar 

  11. Hayakawa K, Mitsuhashi N, Saito Y, et al.: Limited field irradiation for medically inoperable patients with peripheral stage I non-small-cell lung cancer. Lung Cancer 1999, 26:137–142.

    Article  PubMed  CAS  Google Scholar 

  12. Sibley G, Jamieson TA, Marks LB, et al.: Radiotherapy alone for medically inoperable stage I non-small-cell lung cancer: the Duke experience. Int J Radiat Oncol Biol Phys 1998, 40:149–154.

    Article  PubMed  CAS  Google Scholar 

  13. Kaskowitz L, Graham MV, Emami B, et al.: Radiation therapy alone for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 1993, 27:517–523.

    PubMed  CAS  Google Scholar 

  14. Morita K, Fuwa N, Suzuki Y, et al.: Radical radiotherapy for medically inoperable non-small-cell lung cancer in clinical stage I: a retrospective analysis of 149 patients. Radiother Oncol 1997, 42:31–36.

    Article  PubMed  CAS  Google Scholar 

  15. Krol AD, Aussems P, Noordjik E: Local irradiation alone for peripheral stage I lung cancer: could we omit the elective regional nodal irradiation? Int J Radiat Oncol Biol Phys 1996, 34:297.

    Article  PubMed  CAS  Google Scholar 

  16. Gauden S, Ramsay J, Tripcony L: The curative treatment by radiotherapy alone of stage I non-small-cell carcinoma of the lung. Chest 1995, 108:1278–1282.

    PubMed  CAS  Google Scholar 

  17. Graham PH, Gebski VJ, Langlands AO: Radical radiotherapy for early non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 1995, 31:261–266.

    Article  PubMed  CAS  Google Scholar 

  18. Curran WJ Jr, Herbert SH, Stafford PM, et al.: Should patients with post-resection locoregional recurrence of lung cancer receive aggressive therapy? Int J Radiat Oncol Biol Phys 1992, 24:25–30.

    PubMed  Google Scholar 

  19. Dosoretz DE, Katin MJ, Blitzer PH, et al.: Medically inoperable lung carcinoma: the role of radiation therapy. Semin Radiat Oncol 1996, 6:98–104.

    Article  PubMed  Google Scholar 

  20. Slotman B, Njo KH, Karim AB. Curative radiotherapy for technically operable stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 1994, 29:33–37.

    PubMed  CAS  Google Scholar 

  21. Arriagada R, Le Chevalier T, Quoix E, et al.: Astro plenary: effect of chemotherapy on locally advanced non-small-cell lung carcinoma: a randomized study of 353 patients. Int J Radiat Oncol Biol Phys 1991, 20:1183–1190.

    PubMed  CAS  Google Scholar 

  22. Dosoretz DE, Katin MJ, Blitzer PH, et al.: Radiation therapy in the management of medically inoperable carcinoma of the lung: results and implications for future treatment strategies. Int J Radiat Oncol Biol Phys 1992, 24:3–9.

    PubMed  CAS  Google Scholar 

  23. Emami B: Three-dimensional conformal radiation therapy in bronchogenic carcinoma. Semin Radiat Oncol 1996, 6:92–97.

    Article  PubMed  Google Scholar 

  24. Emami B, Lyman J, Brown A, et al.: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991, 21:109–122.

    PubMed  CAS  Google Scholar 

  25. Roach M, Gandara DR, Yuo H, et al.: Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors. J Clin Oncol 1995, 13:2606–2612.

    PubMed  Google Scholar 

  26. Graham MV, Purdy JA, Emami B, et al.: Clinical dosevolume histogram analysis for pneumonitis after 3D treatment for non-small-cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999, 45:323–329. An excellent review of 3D-CRT treated patients with estimations on the development of radiation pneumonitis from the percent of lung tissue exceeding 20 Gy.

    Article  PubMed  CAS  Google Scholar 

  27. Hayakawa K, Mitsuhashi N, Saito Y, et al.: Short communication: adverse chronic effects of high-dose irradiation on proximal bronchus in patients treated for bronchogenic carcinoma. Br J Radiol 1993, 66:477–479.

    Article  PubMed  CAS  Google Scholar 

  28. Jeremic B, Shibamoto Y, Acimovic L, et al.: Hyperfractionated radiotherapy alone for clinical stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 1997, 38:521–525.

    Article  PubMed  CAS  Google Scholar 

  29. Rosenzweig KE, Sim SE, Mychalczak B, et al.: Elective nodal irradiation in the treatment of non-small-cell lung cancer with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 2001, 50:681–685. A large modern series of patients treated with 3D-CRT to involved lymph nodes only with locoregional control data.

    Article  PubMed  CAS  Google Scholar 

  30. Sawyer TE, Bonner JA, Gould PM, et al.: Patients with stage I non-small-cell lung carcinoma at postoperative risk for local recurrence, distant metastasis, and death: implications related to the design of clinical trials. Int J Radiat Oncol Biol Phys 1999, 45:315–321.

    Article  PubMed  CAS  Google Scholar 

  31. Henning GT, Littles JF, Martel ML, et al.: Preliminary results of 92.4 Gy or more for non-small-cell lung cancer. Proc Am Soc Clin Oncol 2000, 48:233–233.

    Google Scholar 

  32. Jeremic B, Shibamoto Y, Acimovic L, et al.: Hyperfractionated radiotherapy for clinical stage II non-small-cell lung cancer. Radiother Oncol 1999, 51:141–145.

    Article  PubMed  CAS  Google Scholar 

  33. Marks LB, Sibley G: The rationale and use of threedimensional radiation treatment planning for lung cancer. Chest 1999, 116:539S-545S.

    Article  PubMed  CAS  Google Scholar 

  34. Saunders M, Dische S, Barrett A, et al.: Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee. Radiother Oncol 1999, 52:137–148. A large Phase III multicenter randomized trial for Stage I-IIIB non-small-cell lung cancer that reveals a reduction in relative risk of death in all stages of disease with accelerated hyperfractionated radiation therapy over standard fraction RT.

    Article  PubMed  CAS  Google Scholar 

  35. Bush DA, Slater JD, Bonnet R, et al.:Proton-beam radiotherapy for early-stage lung cancer. Chest 1999;116:1313–1319.

    Article  PubMed  CAS  Google Scholar 

  36. Hilaris BS, Nori D, Martini N: Intraoperative radiotherapy in stage I and II lung cancer. Semin Surg Oncol 1987, 3:22–32.

    Article  PubMed  CAS  Google Scholar 

  37. Marsiglia H, Baldeyrou P, Lartigau E, et al.: High-doserate brachytherapy as sole modality for early-stage endobronchial carcinoma. Int J Radiat Oncol Biol Phys 2000, 47:665–672.

    Article  PubMed  CAS  Google Scholar 

  38. Saito M, Yokoyama A, Kurita Y, et al.: Treatment of roentgenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low-dose-rate brachytherapy: second report. Int J Radiat Oncol Biol Phys 2000, 47:673–680.

    Article  PubMed  CAS  Google Scholar 

  39. Chemotherapy in non-small-cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 1995, 311:899–909.

  40. Komaki R, Seiferheld W, Curran W, et al.: Sequential vs. concurrent chemotherapy and radiation therapy for inoperable non-small-cell lung cancer (NSCLC): analysis of failures in a phase III study (RTOG 9410). Int J Radiat Oncol Biol Phys 2000, 48:113.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Frankford Hospital Torresdale Division, Knights and Red Lion Roads, 19114, Philadelphia, PA, USA

    Eric L. Gressen MD & Walter J. Curran MD

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  1. Eric L. Gressen MD
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  2. Walter J. Curran MD
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Gressen, E.L., Curran, W.J. Inoperable localized stage I and stage II non-small-cell lung cancer. Curr. Treat. Options in Oncol. 3, 75–83 (2002). https://doi.org/10.1007/s11864-002-0044-x

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  • DOI: https://doi.org/10.1007/s11864-002-0044-x

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