However, there was a suggestion of improved disease-free survival in the N2 subgroup. This study has been criticized for including only patients with squamous cancer (adenocarcinoma and large cell carcinomas may be more radiocurable) and for a high rate (25%) of noncompliance with the radiation therapy dose protocol. In any case, regardless of the controversy over the overall survival data, postoperative radiation therapy does decrease the frequency of local regional recurrences and may prolong disease-free survival. This is a service to the patients as long as complications from radiation therapy can be minimized by careful selection of the patients and the radiotherapeutic techniques.
Small Cell Lung Cancer
Adding radiation therapy to chemotherapy in the management of limited-stage small cell lung cancer increases the complete response rate of the tumor and decreases the intrathoracic relapse rate (Table 8). The latter improves the patients quality of life, and the former can lead to a prolonged survival. Of the variety of combined-modality approaches, concurrent radiation therapy and chemotherapy has demonstrated superior survival. Two recently published controlled trials using concurrent therapy report 2-year survivals on the combined arm of 25% to 30%, statistically significantly greater than the 10% to 15% on the chemotherapy-only arm.
Table 8—Effects of Adjunctive Radiation Therapy in Limited-Stage Small Cell Lung Carcinoma
|Series||Treatment||Complete Response, %||Chest Failure, %||2-Year Survival, %|
|Cancer and Leukemia Group B1H||Chemotherapy alone||36||87||15|
|Chemotherapy and radiation therapy*||54||46||28|
|National Cancer Institute||Chemotherapy alone||43||77||10|
|Chemotherapy and radiation therapy*||81||37||28|
|Southwest Oncology Group||Chemotherapy alone||33||90||20|
|Chemotherapy and radiation therapyt||47||56||20|