Indications for and results of irradiation of carcinoma of the lung

In the majority of patients with pulmonary cancer seen in a radiotherapy department it is not possible to achieve more than short-term palliation. No pretreatment criteria allow the radiotherapist categorically to decide definitely which patients might be cured and which might receive palliation only. A number of clinical features—pain, weight loss of 10 pounds or more, supraclavicular metastases, hemoptysis, large mass requirement treatment fields of more than 200 cm2, or history of resection longer than 6 months earlier—make long-term control unlikely, but some with these signs or symptoms may still be cured. Because one does not want to cause undue morbidity from high dose irradiation in incurable patients, a further attempt must be made to select the favorable cases from the group at large by careful evaluation during treatment. Split-course therapy is suggested as a means of refining this selection process since the rest period allows longer observation prior to commitment to a high dose. It is important that high dose therapy be offered to the favorable patients since as many as 5 to 8% of all referred patients can be cured and approximately 20% can be given long-term palliation. Satisfactory treatment results in the Stanford series were more frequent with doses in excess of 5500 rads in 6 weeks by conventional fractionation.