The treatment results obtained in patients with both small and
non small cell lung cancer have remained stagnant for years. Therefore, in order to select patients who will have a profit from
radiotherapy the indication has to take into account prognostic factors such as
tumor stage, extent of resection, patient's age, lymph node status,
weight loss and the patient's performance status.
Non small cell lung cancer: Postoperative
radiotherapy seems to benefit only in patients with hilar or mediastinal lymph node involvement, where a five-year survival rate of up to 30% of cases can be achieved. Postoperative irradiation should not be applied following curative resection and negative lymph node status (R0 N0). In inoperable cases conventional fractionated
radiotherapy may definitively have a favourable effect on the patient's survival time, even when the treatment was originally intended to be merely palliative. Only those patients will live five years, who received more than 50 Gy to the hilar and mediastinal nodes and at least 60 Gy to the primary lesion. The volume to be irradiated must include the primary
tumor, the ipsilateral and contralateral hilum, the mediastinum, and both supraclavicular regions. If a
Pancoast tumor is present,
radiotherapy alone obtains a similar result as preoperative irradiation followed by resection.
Small cell lung cancer:
Radiation treatment of the primary
tumor region and the lymph drainage area increases the remission rate by roughly 20% compared with
chemotherapy alone, considerably reduces the incidence of local recurrences and exerts a beneficial effect on the survival of the patients. Recently, this has been confirmed by prospectively randomised protocols. Prophylactic brain irradiation has been found to decrease the risk of cerebral
metastases to 4-6% in patients affected by limited disease and complete
tumor remission under
chemotherapy, and to improve the quality of life without, however, showing the benefit on survival time. Future efforts in
radiotherapy should be aimed not only at increasing dose intensities but also at developing less toxic treatment modalities to the benefit of the quality of life.