The Results of Radiotherapy in Cancer of the Lung

My part in this symposium on cancer of the lung has to do with survival of patients treated by radiotherapy. This I propose to fulfill by presenting, en grosse, material which we have seen at the Massachusetts General Hospital during the period extending from 1940 to 1953. During this period we have recorded on our register 772 patients with histologically proved cancer of the lung. All patients have been followed to death or are known to be alive. One hundred and forty-eight patients, or 19 per cent of the total number, for one reason or another received no treatment at all; 385 or 50 per cent received only x-ray treatment. This latter group includes all patients in whom operation amounted to no more than a biopsy, as well as those who were deemed unsuitable for any surgery at all. It will be recognized that this represents a group which is essentially incurable at the onset. All patients in whom the disease was localized and resectable, who were in good enough physical condition to withstand surgery—with the exception, in later years, of those with oat-cell cancer—were treated surgically. Twenty-one per cent of all patients seen, or 163, were so treated. This represents a group of potentially curable lesions. Seventy-six or 10 per cent of the series were treated by surgery followed by irradiation. This was done for one of two reasons; in a few instances for late recurrence in the chest after a period of freedom from the disease following surgery; more commonly, immediately following incomplete removal of the tumor because of extension to the chest wall, pericardium, diaphragm, lymph nodes, or other mediastinal structures. This material, though obviously biased in favor of a surgical approach, is probably representative of what is seen in most clinics where, as in ours, the attitude is that operation is the treatment of choice when applicable to those having a possibility of cure. An evaluation of our results may then be taken as a fair estimate of what can be done by radiotherapy in the group of patients which most of us see. It must not, however, be taken as a critical evaluation of the potentialities of radiotherapy in lieu of surgery. Of those treated by radiotherapy alone—and this of course represents a motley group, no attempt having been made at subclassification—all but 35 per cent were dead within six months after the beginning of treatment, all but 15 per cent in one year, and all but 5 per cent in two. There were a sturdy 4, or 1 per cent, who continued to survive more than five years after treatment, and some of these at least were apparently cured of the disease for which they were treated. More about them later. The calculated median survival time of this entire group is only four months, which is practically the same as that of those who received no treatment at all, where the calculated median survival time was on the order of three months.