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Radiotherapy in the Management of Superior Sulcus Tumors. Enis Özyar MD, Professor of Radiation Oncology Acıbadem University. Application of Radiotherapy. Definitive Preoperative Postoperative Pre and postoperative. Radiotherapy Technique. External Intraoperative external
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Radiotherapy in the Management of Superior Sulcus Tumors Enis Özyar MD, Professor of Radiation Oncology Acıbadem University
Application of Radiotherapy • Definitive • Preoperative • Postoperative • Pre and postoperative
Radiotherapy Technique • External • Intraoperative external • Brachytherapy
Rationale of Preoperative Radiotherapy ? • Improves resectability • Decrasing tumor seeding • Blocking lymphatic channels • Maximizing local control
RT RT Surgery Chemo CRT
Classical Outcomes • Disease free survival • Progression free survival • Overall survival • Early toxicity • Late toxicity
New Outcomes • Resectability rate • Complete resection rate • Pathological comlplete response rate (pCR) • Surgical morbidity and mortality
Preop. Chemoradiotherapy Phase II Prospective Studies • SWOG 94-16 / INT 0160 • Japanase CO6 9806
SWOG 94-16 / INT 0160 Cisplatin Etoposide + RT 45 Gy 110 Mediast. (-) patients Progressive disease Re evaluation 2-4 weeks Stable or response (+) Rusch VW et al., JCO 2007
SWOG 94-16 / INT 0160 Stable or Response (+) Surgery 2 cycles chemotherapy
Post induction Radiological/Pathological Discordance 26 (% 65) 33 (% 72) 14 13
Japanase CO6 9806Study Cisplatin Mito, Etoposide + RT 45 Gy 1 w split 76 pts Progressive disease Re evaluation 2-4 week Stable or Response (+) Kunitoh H. et al., JCO 2008
Japanase CO6 9806Study Stable or response Surgery No Response Radiotherapy Boost Kunitoh H. et al., JCO 2008
Are there a role for cranial prophylaxis ? • Retrospective analysis, • SWOG 9416 protocol and similar patients • CNS metastasis in 10 out of 33 (% 30) patient • Role of prophylaxis should be investigated Sun et al., Lung Cancer Proce. 2005
What to do in daily practice ? Mediast. Evaluat. Surgery PET N0, N1 N2 and >
What to do in daily practice ? N0, N1 Preop. CRT Doublet + 45 Gy Surgery N2 and > Surgical inop. CRT Doublet + >60 Gy
Conclusions • Mediastinal staging is important • Single modality results are inadequate (KT, RT • ve surgery) • SWOG preop CRT and surgery results better outcome • Multidisciplinary approach
Technical Aspects of Radiotherapy • 2 Dimensional • 3 Dimensional Conformal • IMRT • IGRT • Gated Radiotherapy • Stereotaktic Radiotherapy
3 Dimensional RT IMRT
3 Dimensional RT IMRT Dose distribution
What is the Impact of Advanced Radiotherapy Technology ? • More respect to normal tissues • Irradiation of tumor with better coverage and dose escelation • Increase in local control • Decrease in toxicity