Non-small-cell lung cancer: should unresectable stage III patients routinely receive high-dose radiation therapy?
Non-small-cell lung cancer patients who have unresectable mediastinal disease have a poor prognosis regardless of therapy administered. The various rationales for high-dose radiation therapy with curative intent are reviewed in the context of treatment results reported in the literature. The case for a dose-cure relationship in a clinically practical dose range must be considered unproven. On the other hand, the evidence for dose-response effects suggests that higher dosages could result in improved quality of life. There is a need to further refine reproducible criteria, both anatomic (such as mediastinal involvement) and non-anatomic (such as performance status), to permit more appropriate selection of patients for high-dose treatment. Studies involving less rather than more treatment with appropriate endpoints might be both ethical and appropriate.
Payne
D G
DG
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario.
D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy*; D004992:Ethics, Medical; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011788:Quality of Life