Preoperative radiation therapy in the treatment of bronchial carcinoma

Three hundred and thirty-one selected male patients with biopsy-proven bronchial carcinoma were randomized into two groups: 166 patients received preoperative radiation therapy and subsequent surgery and the other 165 patients underwent surgery alone. One hundred and six operations were performed in the pretreatment group and 153 in the control group; of these, 20 and 63 patients, respectively, underwent thoracotomy only. All patients are now eligible for 4-year survival or more, and no increase in survival is noted in the pretreatment group. In those patients in each group who underwent successful resection, survival again was not increased in the pretreatment group; in fact, the survival rate in the preoperative treatment group was significantly less during the first 12 postoperative months than in those patients who only underwent operative removal of their tumor. The survival rate continues to be less in the pretreatment group, 12.5% vs. 21%, although the difference is not statistically significant. Thus, it has been concluded that the routine use of preoperative irradiation in patients with bronchial carcinoma is not beneficial and indeed may well be harmful.