Total-lung irradiation in the treatment of pulmonary metastases.

Sixty-two patients with pulmonary metastases from a variety of primary malignant neoplasms were treated with total-lung irradiation. The incidence of radiation pneumonitis was 21%(13/62) overall, rising to 23% (9/39) in those receiving a tumor dose of 1,500 rads or more. Nine patients with radiation pneumonitis were given chemotherapy (actinomycin D) together with irradiation, and in this group the incidence of radiation pneumonitis was 25%. Five survivors, including 4 treated for metastatic Wilms' tumor, were treated more than 13 months prior to analysis without evidence of disease thus far. Total-lung irradiation for primary malignant neoplasms other than Wilms' tumor does not presently appear to be indicated. A dose of 1,500 rads in 2 weeks in conjunction with actinomycin D is recommended for metastatic Wilms' tumor.