European Journal of Cardio-Thoracic Surgery, Vol 4, 85-89, Copyright © 1990 by European Association for Cardio-thoracic Surgery
Intraoperative radiation with external irradiation: an alternative for nonresectable non-small-cell lung cancer?
FM Juettner, K Arian-Schad, G Leitner, G Porsch, G Flueckiger, G Kopp, F Ebner, J Smolle, H Popper and A Hackl
Department of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria.
In 15 patients with nonresectable non-small-cell lung carcinoma (NSCLC) (10
squamous, 1 large cell, 4 adenocarcinomas; T1-T3, N0-N2, all M0), lymph
node dissection and intraoperative irradiation of the tumour (IORT) with
doses between 10 and 20 Gy (11-20 MeV electron beam) was performed. Four
weeks postoperatively 46-56 Gy external irradiation (8 or 23 MeV photons)
was delivered to the mediastinum and 46 Gy to the tumour-bearing area. Four
weeks postoperatively, 8 minor responses (MR, tumour regression between 4%
and 45%) and 6 partial responses (PR, 50%- 84%) were found. In 1 case, CT
was inconclusive. Eighteen weeks after IORT, volumetry showed 3 CR, 9 PR
(62% to 94%) and 1 28% MR. One patient died from intrabronchial hemorrhage
7 weeks after IORT (50% PR). Two others (both CR) died from unrelated
causes, 6 and 12 months, respectively, after IORT. One patient (62% PR)
died after 14 months from an unknown cause. Another patient died at 15
months from local relapse after CR. The latest CT volume assessment between
7.5 and 21.5 months, respectively, yielded 8 CR, and 1 63% PR. One further
case of local CR has developed contralateral pulmonary metastasis after 10
months. All these patients are alive and well. The median time elapsed
since IORT is 12.5 months, 10 patients have survived more than 12 months.
