AB 13. The effect of 3D conformal radiotherapy to the left lung cancer, in cardiovascular system and the other organ at risk. The experience in Univercity General Hospital of Thessaloniki, AHEPA

Background: Gradually, more patients with Lung Cancer, survive and the quality of their life compose a focus such as is disturbed from the side effects of treatment. It is known the toxicity of cardiovascular system, the spinal cord, esophagus, from therapies as: chemotherapy and radiotherapy. Radiotherapy to the lung cancer (± chemotherapy) causes acute and chronic cardiac toxicity such as acute pericarditis, arrhythmias and pericardial effusion, increased atherosclerosis and constrictive pericarditis (after irradiation). The risk is greatest with left lung irradiation and radiation involving the mediastinum. The effect of 3D Conformal radiotherapy to the left lung cancer or/and mediastinum, in the organs at risk (OAR), as heart, spinal cord, esophagus, unilateral lung.
Patients and methods: A total of 17 patients with Left lung cancer came in radiation therapy departments in U.G.H.Th.AHEPA, in the year 2010. A total of 12 patients received radiotherapy (RT) in mediastinum and the tumor mass, and 5 patients received RT only in the tumor mass and left hemithorax. All of them were submitted in chemotherapy and 9 from were them in concurrent chemo-radiotherapy. All the patients were irradiated after CT based simulator, 2D-3D Conformal treatment planning, with linear accelerator with Multilief collimator-(MLC), which allows for the better protection of normal tissue structures (OAR). Treatment planning was with 3-4 fields for irradiation the clinical target Volume (CTV) and determination of the OAR from the Radiation Oncologist Medical Doctor. The Medical Physics have made in detailed the DVH-dose Volume Histogram. Patients were irradiated in 28-30 franctions with 200 cGy/fraction (Total dose: 56-60 Gy). They received 44 Gy in the mediastinum and BOOST (= supplementary tumor dose) in the tumor mass (16 Gy).
Results: All the patients were under observation and in the follow up during their therapy and after the end of the definitive fractions, for 3, 6, 12, 18, 24 months, there was no side effects on the cardiovascular system such as acute pericarditis, pneumonitis, myelitis after irradiation. 8 patients, after irradiation in mediastinum and the tumor mass (with 60 Gy) revealed esophagitis Grade I-II which retreated 20 days after the end of RT.
Conclusions: Equipment for treatment and planning the field of radiotherapy through the use of 3D conformal therapies and Linear accelerator with MLC, minimized greatly the amount of radiation which is received by organs at risk such as the heart, spinal cord esophagus. Patients with left lung cancer can receive the maximum therapeutical dose without acute or chronic cardiovascular complications. Further developments include the use of IMRT and free breathing gating to decrease the risk of cardiovascular complications especially in young patients with left lung cancer. So with minimized toxicity we have an increasment in the overall survive and improvement in the quality of life.