New strategies in radiation therapy of bronchogenic carcinomas

The role of radiation therapy in the management of resectable and non-resectable bronchogenic carcinomas is better defined today than some years ago. Oat cell bronchogenic carcinomas are treated in applying a sandwich technique of chemotherapy - radiotherapy - chemotherapy. Radiotherapy of the mediastinum with 46 Gy / 4-6 weeks significantly increases the remissions; as statistics show, reduces the intrathoracic relapses and is very tolerated. Prophylactic cranial irradiation lowers the frequency of manifest cranial metastases considerably. In cases of non oat cell bronchogenic carcinomas the post-operative radiotherapy can prolong the disease free survival of those patients, who show positive lymph nodes during the curative, relatively curative or non-curative resection. The prognosis of patients, however, whose regional lymph nodes are not affected, is not improved, but rather deteriorated. When irradiating non-resectable non-oat cell bronchogenic carcinomas, the dose per fraction, the total dose and the volume of irradiation are of decisive importance. We recommend an individual high-dose enbloc technique and at least 60 Gy tumour dose in 4-5 fractions per week in an overall treatment time of 6-7 weeks. (orig.)