AB 15. The role of glutamine in prevention and in the treatment of radiation esophagitis, in the treatment of lung cancer with radiotherapy and chemotherapy
Background: The Lung cancer is the most frequent cancer in the
world, such as the most frequent cause for death of cancer. Treatment
as chemotherapy and radiotherapy are increasing the overall survival.
Toxicity and side effects during the treatment, some times, are intensive
and have affected in the quality of life of the patients. Very important
is the role at glutamine in the per os prevention and the treatment for
after irradiation esophagitis. The protective effect of glutamine in the
patients with lung cancer which are treated with radiotherapy or/and
chemotherapy.
Patients and methods: A total of 150 patients with lung cancer were
treated with radiotherapy in the year 2011, in the radiation department
of U.G.H.Th.AHEPA. Most of them were treated with chemotherapy
before or/and during the period of radiotherapy. The total radiation
dose was 55-60Gy in the tumor mass and 44Gy in the mediastinum. The
patients received 3D Conformal radiotherapy with linear accelerator
with Multilief collimator, after CT simulator. One week before
radiotherapy in 110 patients was given glutamine 30 gr/day per os. They
continued during therapy (~6 weeks) such as ~ one month after the
end of fractions. 40 patients refused to take glutamine per os or/and not
tolerated treatment with glutamine. All of them concluded the fractions
of RT. They were under observation for the toxicitim of the side of
esophagus, pain and dysphagia. Concurrently we have give instructions
for diet and treatment with antimycotic drugs.
Results: In the weekly follow-up, all the patients which have taken
glutamine, before, during and after the end of therapy (radio ±
chemotherapy) presented with mild toxicity: esophagitis Grade I, mild
pain, dysphagia Grade O-I. The symptoms relieved two weeks after the
end of RT fractions. A total of 25 patients who have not take glutamine
presented with esophagitis Grade II. After 20 fractions of RT in these
patients presented loss of weight loss of apetit, fatigue, myalgia, nausea.
The symptoms relieved 1½ month after the end of RT fractions. A total
of 15 patients who have not take glutamine, presented esophagitis Grade
III with dysphagia Grade III and causalgia in esophagus. The patients
presented loss of weight (~10 kg), myalgia and intensive fatigue. The
symptoms retreated two months after the end of radiotherapy.
Conclusions: Its acceptable the positive effect of glutamine, per os, in
the prevention and the treatment of toxicity due to radio-chemotherapy
in patients with lung cancer. Decrease in minimal esophagitis after
irradiation. So, 3D Conformal radiotherapy (in high doses) or/and
chemotherapy, gives the best results increasing the overall survival and improve the quality of life.
