Comparison of Three Different Methods of External Irradiation, and Their Results, in the Treatment of Inoperable Carcinoma of the Lunq

Abstract

The steadily increasing number of patients who are referred for radiotherapy with the diagnosis of advanced inoperable carcinoma of the lung has become a challenge and a problem during the past few years. The solution has not been made easier by the wide range of opinions as to the clinical approach to the disease. Some clinicians have questioned the value of any type of therapeutic interference in such a situation and have felt that no treatment whatever was indicated unless patients were threatened by compression of vital organs, while others have considered aggressive therapy imperative and worthwhile. It has always been the opinion of the writer that supervoltage irradiation offers the most to patients with far advanced inoperable cancer of the lung, and she has accordingly treated such patients with 2-million-volt or cobalt-60 irradiation. Since the results of this treatment approach have been published previously, only those data which are most pertinent to the present discussion will be summarized here. One hundred and fifty-three patients with microscopically proved inoperable carcinoma of the lung have been treated and followed in the Radiotherapy Department of the Francis Delafield Hospital, New York, since 1953. Of these, 138 were treated with a 2-million-volt unit, and 15 with a cobalt-60 unit. It has been our rule to accept every patient for radiotherapy without exception, no matter how far advanced the disease either locally or in lymph nodes, or both. Radiation has been administered through two opposing fields, with a daily tumor dose of 200 r, for a total tumor dose of 5,000 r in the majority of the cases and in a few patients as much as 6,000 r. Neither rotation therapy nor scanning has been used, as we believe that the preservation of the unimpaired function of the healthy opposing lung is essential for survival. The tolerance has been very good, as was to be expected with the use of 2-million-volt or cobalt-60 therapy. Three observations of considerable interest have been made in the course of this study: 1. It has been possible, with the external radiation doses used, to sterilize even large carcinomas of the lung. 2. Malignant lesions of the epithelium have responded far better than those of glandular tissues. 3. There is no correlation between clinical success and roentgenologic findings; the films of most patients will show only little change, as large tumors which have often caused many changes in the surrounding tissues do not melt away under radiotherapy. In addition, radiation pneumonitis, pleurisy, and fibrosis appear quite frequently and, persisting for the duration of the patient's life, make it practically impossible to determine correctly alterations in the original tumor shadow on subsequent roentgen studies.