Treatment of pulmonary metastatic disease with radiation therapy and adjuvant actinomycin D.Preliminary observations

The records of 46 Mayo Clinic patients who had received roentgen therapy to die lung, with adjuvant actinomycin D, as treatment for metastatic pulmonary disease were reviewed. The dates of the retrospective study were from January 1962 through April 1967. Roentgen therapy was administered according to 2 schedules and directed through portals encompassing either a hemithorax or the entire chest. Thirty-six patients each received daily fractions 6 times a week, achieving a total dose of 1,500 rads, as measured at the midplane of the thorax; the usual daily midplane dose was 100 rads. The remaining 10 patients each received a total dose of 1,200 rads in 8 treatments to portals encompassing both lungs. Actinomycin D was given to all 46 patients by direct intravenous infusion. The usual dose was 5.1 μg/kg/day for an average of 12 days. Three significantly long regressions were obtained with this program of combined therapy: 51, 28, and 18 months. However, 7 of the 18 patients in whom there was a response had lesions that would ordinarily be considered sensitive to radiation therapy alone. Because almost all of the patients experienced significant morbidity, this program cannot be recommended as routine treatment at the present time.