AB 39. Definitive - radical external radiotherapy (EBRT) with 3D conformal RT in patient with unresectable T4 pancoast lung cancer. Review in the literature

Background: The Pancoast tumor or the Non-Small cell Lung Cancer (NSCLC) in the superior sulcus, accounts only 5% of all NSCLC. Usually these tumors appears with pain of upper extremities, shoulder pain, numbness, and fatigue from entanglement of plexus brachialis. Due to restrictive area in the superior sulcus the surgical excision is difficult technical. The “historic therapy” of the Pancoast tumors was “preparatory” EBRT or/and chemotherapy, followed by surgery. The five years overall survival was 30% only with RT and 41% after combination with preoperative radio-chemotherapy. When the Pancoast tumor is unresectable (T4), the radical external radiotherapy (EBRT) with high therapeutical doses is a preferable option for treatment. The current role of radical external 3D conformal EBRT in patient with T4 Pancoast Lung cancer tumor.

Patients and methods: Patient 58 years-old, with T4 Pancoast tumor mass (Left lung cancer) came in April 2011with pain in his left shoulder, numbness and fatigue. The CT of thorax showed tumor mass of left superior lob in the superior sulcus (T4 Pancoast tumor). It was unresectable. The patient was treated with radical RT after the CT-simulation, definition of CTV (clinical target volume) and the organs at risk (OAR), from the radiation oncologist. It was done 2D- 3D treatment planning, DVH (dose volume histogram). The patient received 60 Gy with 2 Gy/fraction in 30 fractions, in the tumor mass, with linear accelerator with Multilief Collimator (MLC) for avoidance the organs at risk- spinal cord, heart, unilateral lung and esophagus. The mediastinum irradiated with 44 Gy in 22 fractions and continuing in the tumor mass-BOOST (= complementary tumor dose), in 16 Gy in 8 fractions (five days/weekly). There were designed 4 radiation fields. Results: The patient, after the first week during the fractions of radiotherapy was refered with remission of pain and numbness of the left shoulder. He reduced the doses and the frequency of analgetics. He completed the radiotherapy with mild esophagitis Grade O-I and rehabilitated his muscular function. The respiratory function was completed satisfying. One month after the end of radiotherapy, the CT of thorax showed reduced of the Pancoast tumor mass.

Conclusions: The 3D conformal EBRT compose “engaging” therapeutical approach, when the Pancoast tumor is unresectable. The radical EBRT, alone, in high total doses, increase the overall-survival in these patients and in this way we avoid the toxicity of the organs at risk and there is improvement in their quality of life.