מתוך medicontext.co.il
NEW YORK (Reuters Health) – When 3-dimensional conformal radiation therapy (CRT) is the treatment for non-small-cell lung cancer, gross tumor volume is more highly associated with patient survival and tumor control than other prognostic factors.
At the Washington University Medical Center in St. Louis, 207 patients deemed inoperable but without evidence of metastatic disease underwent CRT between 1991 and 1998. One- and 2-year survival rates were 59% and 41%, respectively, Dr. Jeffrey D. Bradley and associates report in the International Journal of Radiation Oncology, Biology and Physics for January.
In multivariate analysis, only gross tumor volume and histologic tumor type–squamous versus nonsquamous–significantly affected overall survival and local tumor control. The effects of other factors considered important in surgical therapy–tumor stage, nodal stage, and overall clinical stage–were not significant. Among the 95 patients with stage III disease who received chemotherapy, outcomes were unaffected by the additional treatment.
The Missouri investigators suggest that "bulky disease, stage for stage, has a poorer prognosis than low volume disease when treated with definitive radiotherapy."
Tumors of all sizes treated with doses of at least 70 Gy exhibited significantly improved local control and cause-specific survival compared with those treated with lower doses, but overall survival was not affected. However, the investigators note that this finding was subject to selection bias, and that phase III dose-escalation studies are warranted.
In a university statement, Dr. Bradley notes that CRT may be an appropriate strategy for patients with small tumors for whom surgery is ill-advised. Those with large tumors, on the other hand, could be treated less aggressively, he suggests. "These patients may be better treated with lower doses of radiation to help control their symptoms rather than large doses that try to eliminate the tumor," he states.
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