Observations on the treatment of mediastinal masses in XXXX emphasizing site of failure.

@entity1 @entity978 @entity3052
Of 244 @entity1 with @entity978 , 126 (52%) had an abnormal mediastinum. Sixty-four @entity1 were treated with radiation, 36 with radiation and chemotherapy, and 25 with chemotherapy alone as an initial treatment. Twenty of 52 (38%) with stage I or II who received initially radiation alone relapsed, and 70% (14 of 20) of them were salvaged with chemotherapy. Therefore, the ultimate failure rate was 12% (6 of 52). Forty percent (8 of 20) of these @entity1 failed within or at the margin of the radiation portal, and 60% failed predominantly outside of the radiation field. Even though we did not treat the whole lung prophylactically, there was only one true peripheral lung recurrence. Nine of 20 (45%) recurred in more than one site. Of 36 @entity1 treated with combined radiation and chemotherapy, 21 @entity1 had stage I, II, or IIIA disease. Of these, two @entity1 relapsed. Of 86 @entity1 with accessible x-ray films, 30 @entity1 had large masses with a ratio of mass to transverse diameter greater than .33 at the broadest level. Fifty-six @entity1 had small masses. Survival at 96 months in @entity1 with stages I-IIIA with either large or small masses is 94% (p = 0.80). Their relapse-free survival at 96 months is 79% for large masses and 95% for small masses (p = 0.18). The site of relapse is discussed in detail in the text. There were five treatment-related deaths; three @entity1 died of @entity3052 . Our data do not support the role of whole-lung prophylactic irradiation or initial combined radiotherapy and chemotherapy in @entity1 with large mediastinal masses.
