Chemoradiation (CRT) induced esophageal toxicity (ET) of the treatment of non small cell lung cancer (NSCLC)

Aim: The aim of our study was to evaluate the dosimetric correlation of acute ET of the neoadjuvant and definitive taxan based CRT of the NSCLC in our practice.

Patients and Method: We analysed the CRT of 27 pts (age 58.8 (39–78), ECOG 0–1) with NSCLC (stage II: 5, III.A: 3, III.B: 19; 16 adeno-, 2 bronchioloalveolar- and 9 squamous cell carcinomas). Prior the CRT 9 pts received chemotherapy (CT). Concomittant CRT included weekly paclitaxel 100mg/m2 (4–6 cycles) and 3D conformal radiotherapy (RT), using individual immobilization and MLC-collimated 15MV fotonfields (mean 3.8±1.1 fields). The planning target volume encompassed the macroscopic tumor and the involved lymph node regions (mediastinal and ipsilateral hilar). The dose was 45 + 22–26Gy (1.8Gy/fr). Esophagus was delineated in whole length. We analysed the early esophageal side effects (graded according to Common Toxicity Criteria (CTCAE 0.3)) in correlation to the dose.

Results: Complex treatment of 23 pts. were completed. 2 CT had to be stopped due to allergic reaction and intolerability. 2 pts had progression. In 6 cases the RT had to be transiently interrupted due to toxicity (gastrointestinal and haematological side effects and neutropenia). The average dose (Gy) to the contralateral lung was 10.8±4.4 and spinal cord 12.0±5.8, respectively. We observed no grade 4, 1 grade 3, 12 grade 2 and 10 grade 1 esophageal reactions. In the cases with grade 2 and 3 toxicity the maximum dose (Dmax) was >56Gy and the 30% of esophageal volume (D30) received >50Gy. Conclusion According to our results, the acute ET following definitive CRT is common but rarely severe. The severity of ET shows correlation with the esophageal Dmax and D30.