Place de la radiothérapie médiastinale postopératoire dans les cancers pulmonaires non à petites cellules

[Postoperative radiotherapy for non-small cell lung cancer: Efficacy, target volume, dose]

The rate of local failure of stage IIIA-N2 non-small cell lung cancer is 20 to 40%, even if they are managed with surgery and adjuvant chemotherapy. Postoperative radiotherapy improves local control, but its benefit on global survival remains to be demonstrated. Considered for many years as an adjuvant treatment option for pN2 cancers, it continues nevertheless to be deemed too toxic. What is the current status of postoperative radiotherapy? The Lung Adjuvant Radiotherapy Trial (Lung ART) phase III trial should give us a definitive, objective response on global survival, but inclusion of patients is difficult. The results are consequently delayed. The aim of this review is to show all the results about efficacy and tolerance of postoperative radiotherapy and to define the target volume and dose to prescribe.

Radiation pneumonitis in patients with non--small-cell lung cancer treated with erlotinib concurrent with thoracic radiotherapy

INTRODUCTION

The aim of this study was to investigate the incidence of radiation pneumonitis in patients with non-small-cell lung cancer treated with concurrent thoracic radiotherapy and erlotinib.

METHODS

Patients with inoperable stages IIIA to IV non-small-cell lung cancer who were treated with concurrent thoracic radiotherapy and erlotinib were analyzed. The incidence of radiation pneumonitis was evaluated using the Common Toxicity Criteria (CTC) 3.0 Grading System. The development of grade 2 or higher radiation pneumonitis was the study end point.

RESULTS

Among the 24 patients analyzed, there were nine developed radiation pneumonitis of grade 2 or higher (37.5%), including four cases of grade 2 radiation pneumonitis (16.7%), two of grade 3 radiation pneumonitis (8.3%), and three of grade 5 radiation pneumonitis (12.5%). Three patients developed fatal pneumonia and died of bilateral lung radiation pneumonitis.

CONCLUSIONS

Radiation pneumonitis should be considered in patients treated with concurrent thoracic radiotherapy and erlotinib.