[Locally advanced non-small cell lung tumors: curative or palliative radiotherapy]

The best treatment for inoperable "non small cell" lung cancer remains unknown. While metastatic patients are usually treated palliatively, the therapeutic course for locally advanced disease is less clear cut and more controversial. The common habit was been to treat these patients only when disturbing symptoms are present. But this is now changing, because defined radiotherapy techniques and combinations with chemotherapy and/or radiosensitizers produce better results. Also, in palliative treatments new dose-fractionalised schemes are being sought, with the aim of less discomfort and better efficacy. Two clinical trials are presented. The first is a palliative, 10 Gy single-dose treatment of 17 patients with chest symptoms. Results have been encouraging: 67% symptoms palliated at 1 month from treatment. Palliation was however short: 42% at 2 months, 32% at 3 months. The low incidence and mildness of acute complications in this small number of patients permit us to conclude that the treatment is feasible and tolerable; short-lived palliation could be used in patients with a short life expectancy. In the second study, was a multimodality treatment-polychemotherapy (Cisplatin 100 mg/mq days 1, 22 and Vinblastine 5 mg/mq days 1, 8, 15, 22) followed by radiotherapy (60 Gy/30 fractions/42 days) with Cisplatin (5 mg/mq/d) as a radiosensitizer. 15 patients have been recruited, but only 7 could be evaluated. 5/7 objective responses were observed (3 complete). Whole acute toxicity is acceptable. The lack of data concerning late toxicity does not allow conclusions about the feasibility of this therapeutic.