EP1.01-46 Acute Esophageal Damage in Patients with Inoperable Non-Small Cell Lung Cancer Treated with Concurrent and Sequential Chemoradiotherapy

Abstract

Acute esophageal damage may be dose-limitation factor for application of the full planning radiotherapy dose in patients with inoperable Non Small Lung Cancer-NSCLC. Combination of chemotherapy and radiotherapy may increase esophageal toxicity, however three-dimensional conformal radiotherapy offers better spearing. To evaluate the treatment results, study of 75 patients was randomly assigned to one of the two treatment arms. In the sequential arm, 26 (34.7%) patients had previously received sequential chemotherapy with 4 cycles of carboplatin and etoposide followed by conformal radiotherapy (RT). In the second concurrent arm, 49 (65.3%) patients received concurrent chemotherapy of cisplatine and etoposide and conformal RT. We described all phases of the conformal RT. Treatment-related toxicities were assessed according RTOG/EORTC criteria. From 2010 to 2013, 73 patients were enrolled in this study. From all included patients, 43 (57.3%) did not present any grade of esophagitis during the treatment. In sequential group 73.1% presented no esophagitis and in concurrent group 49%, respectively. Although there were differences between the two groups, none was statistically significant. The median survival was 13 months for the patients in the sequential arm and 17 months for those in the concurrent treatment arm. The differences were statistically significant (log-rank test p=0.0039). Table 1 and 2 present grade of ezophagitis and the needs of analgesia in the patients of sequential and concurrent treatment arm. The risk of esophagitis was 22%, in patients whose esophageal volume (V50) recieved less than 30% of prescribed dose in comparation, the risk of esophagitis was 71%, in patients whose V50 recieved dose higher than 30% (p=0.0009).View Large Image Figure ViewerDownload Hi-res image Download (PPT) The reason for good tolerability of the combination of chemotherapy and radiotherapy for patients in this study is using three-dimensional conformal radiotherapy. Further improvements may be obtained with more sophisticated radiotherapy techniques or by using radio protective drags.