Postoperative 3D conformal radiation therapy with dose-volume histogram assessment in non small-cell lung cancer

Background: Despite many randomized trials, the indication of postoperative radiation therapy (PORT) in non small cell lung cancer (NSCLC) is controversial. Involved-field conformal (3D) RT has never been studied prospectively. In this study, we aim to assess the outcome of patients treated with involved-field 3D PORT with or without chemotherapy in locally advanced NSCLC. Materials and Methods: From 1990 to 2006, data from 75 consecutive patients treated with curative surgery and PORT for NSCLC were retrospectively analyzed. Male to female ratio was 57/18, and median age was 58 years (38−76). There were 5 patients with stage I, 22 with stage II, and 48 with stage III disease. Pneumonectomy or lobectomy was realized in 24 and 51 patients, respectively. Mediastinal lymphadenectomy was performed in all patients. PORT indications were positive margins and/or positive mediastinal lymph nodes. Cisplatinbased chemotherapy was given in 15 patients. All patients had 3D conformal planning. Median RT dose was 60 Gy using at least 6-MV photons in 6 weeks, and CTV included bronchial stump and only positive nodal areas. Dose-volume histograms (DVH) assessing the pulmonary volume receiving 20 Gy (V20 Gy) were used in all patients. Results: Compliance to PORT was 100%. In a median follow-up period of 55 months, 26 (35%) patients are alive without disease. Median overall survival time was 24 months, with survival rate of 35% at 5 years. The 5-year locoregional control and distant disease-free rates were 80% and 57%, respectively. Patients treated with pneumonectomy and those treated with at least 60-Gy PORT had better outcome. Grade 3 or more CTC v3.0 toxicity was observed only in 4 (5%) patients. No lethal toxicity was observed. Conclusions: We conclude that involved-field 3D conformal 60-Gy PORT tailored with DVH V20 Gy assessment improves locoregional control without increasing lethal toxicity. Prospective studies using the abovementioned criteria are warranted

Decrease in hemoglobin levels following surgery influences the outcome in head and neck cancer patients treated with accelerated postoperative radiotherapy.

AIM: To assess the influence of hemoglobin (Hb) levels in locally advanced head and neck cancer (LAHNC) patients treated with surgery and postoperative radiotherapy (PORT). MATERIAL AND METHODS: Pre- and postoperative Hb levels were collected in 79 patients treated with surgery followed by accelerated PORT for LAHNC. Median follow-up was 52 months (range 12-95 months). RESULTS AND DISCUSSION: Four-year overall survival (OS) rate was 51%. Neither pre- nor postoperative Hb level (<120 or 130 g/l in women or men, respectively) influenced the outcome. However, when Hb decrease between pre- and postoperative Hb values was taken into account, 4-year OS was significantly higher in patients with Hb difference less than 38 g/l (quartile value) compared with those with Hb decrease 38 g/l or more (61% versus 16%, P = 0.008). CONCLUSION: Decrease in Hb level by more than 38 g/l after surgery secondary to blood loss influences the outcome when postoperative RT is indicated