The Results of Radiotherapy of Bronchial Cancer

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Abstract
The rise in bronchial carcinoma deaths in the last two decades suggests that the place of radiotherapy in the treatment of this disease should again be reviewed. It is estimated by one observer that about 2 per cent of males now living will have bronchial cancer (16). In the population of the United States at large, the 1953 death rate from this cause was approximately 14 per 100,000; in males between the ages of sixty and seventy, it was about 100. The prevalence rate (i.e., the number of persons living at any one time with bronchial cancer, per 100,000 living persons) is reported at widely differing levels in different parts of the country. In the entire United States it is calculated to be between 1 1∕2 and 1 2∕3 the mortality rate. For the year 1953, for example, the approximate prevalence rate for males over forty-five was 110, and for males of sixty to seventy about 160 (7, 17). There is disagreement in the literature as to the efficacy of radiotherapy in bronchial cancer, even when used for palliation (10, 13, 21, 22). This is understandable in view of the short survival of most patients and the fact that irradiation is often deferred until the disease is advanced. Those who have employed radiotherapy extensively, however, report favorably on its usefulness in properly selected cases and emphasize that, while survival time is seldom prolonged, the patient is usually made more comfortable. The most effective curative treatment for carcinoma of the lung remains resection, simple or radical, depending on the stage and type of disease and the condition of the patient. The proportion of patients eligible for curative resection remains relatively small, however, ranging from about 20 per cent of those having symptoms to about 40 per cent of those without, the latter largely representing x-ray survey-detected cases. Between 80 and 60 per cent of persons with bronchial cancer, therefore, are still not amenable to curative surgery at the time their tumor is diagnosed. The results of radiotherapy in a series of patients in this group will be considered. Material Two groups of cases were studied, (A) patients seen at the San Francisco Hospital during the last two and a half decades and (B) patients seen in private practice during the last decade. (A) The San Francisco Hospital is a 1,200-bed institution for the care of the indigent; it is a teaching hospital, staffed by physicians from the two medical schools in the city, and does not maintain an active outpatient clinic. The recorded cases diagnosed as bronchogenic carcinoma during the period of study numbered 623. Convincing cytologic or histologic data were lacking, however, in 103 cases, and therefore only 520 are included in the present summary.

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