The Annals of Thoracic Surgery, Vol 44, 14-20, Copyright © 1987 by The Society of Thoracic Surgeons
Delivery of intraoperative radiation therapy after pneumonectomy: experimental observations and early clinical results
HI Pass, WF Sindelar, TJ Kinsella, AM DeLuca, M Barnes, S Kurtzman, H Hoekstra, Z Tochner, J Roth and E Glatstein
Intraoperative radiation therapy (IORT) is capable of delivering high doses
of radiation to mediastinal structures while sparing lung parenchyma,
heart, and other locoregional tissues. A canine model of pulmonary
resection and IORT was investigated by performing a pneumonectomy in 15
adult foxhounds followed by 0 cGy, 2,000 cGy, 3,000 cGy, 4,000 cGy. No
clinical complications developed in 4 animals in the 2,000-cGy group.
However, 2 of the 8 animals given a high dose died of esophageal hemorrhage
or carinal necrosis. Esophagitis occurred in 10 of 12 animals, and none of
the animals experienced bronchial stump dehiscence. In a limited Phase I
protocol, 4 patients with non-small cell lung cancer were treated with
resection and 2,500 cGy of IORT to two separate ports encompassing the
superior and inferior mediastinum. Two patients experienced
life-threatening bronchopleural fistulas, and 2 patients died as a
consequence of esophageal problems. One patients had recurrence with brain
metastases, and the 1 long-term survivor is free from disease. As opposed
to the animal model of thoracic IORT, the clinical study demonstrated major
toxicity with respiratory and esophageal morbidity. The therapeutic
usefulness of thoracic IORT in the management of lung cancer must be
questioned in view of this small but consistent series of patients. Further
carefully designed clinical studies using lower doses of IORT are needed.
