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The journal «ONCOSURGERY» 2012, Vol.4, No 3

Stereotactic conformal radiotherapy in patients with lung cancer and cardiovascular pathology

Anikeeva ОYu, Polovnikov ЕS, Bednyi IV, Filatov PV

Russian Novosibirsk Research Institute of Blood Circulation Pathology named after EN Meshalkin, Novosibirsk, Russia
Contact: Anikeeva ОYu, e-mail: ,

The techniques of stereotactic radiotherapy in patients with non-small cell lung cancer with concurrent cardiovascular pathology with active breathing control system is represented in the article.

Material and methods: stereotactic conformal radiotherapy was performed in 26 patients with non-small cell lung cancer with cardiovascular co-morbidity, treated in the department of radiotherapy in RNRIBCP named after E.N. Meshalkin in period from September 2010 to March 2012. The median age was 67 y.o. (48-80). The patients had verified histological diagnosis in 83% of cases and had severe concurrent cardiovascular pathology of different degree. The ratio between men and women was 3:1, mean tumor diameter accounted for 6±2.8 cm, in most cases centrally located (61%), disease stage did not exceed IIB-IIIА, respiratory failure had no more than IIst. Radiotherapy was performed with stereotactic linear accelerator. The protocol of treatment planning included multiplanar CT topometry, contouring and superposition of images were performed on station for contouring Focal Pro, calculation of treatment plan on planning system Ergo ++. Different fixation devices were used with image control system (IGRT). The treatment was performed with active breathing control (ABC), for moderate inhale with breath-holding on average by 15-18’, by means of volumetric modulated arc radiation.

Results. The significant increase of average total dose for radical radiotherapy using АВС with average dose of 70+4 Gy. This was associated with more frequent central non-small cell lung cancer and higher tolerance rate in critical organs (esophagus, mediastinum, heart, spinal cord). Additionally, АВС allowed to perform radiotherapy without break of course in 70% of cases, thus increasing local control for tumor. Interim results showed no signs of disease progression in 66% of cases. In 15% of cases disease progression occurred 18+3 week later, requiring polychemotherapy, 12% of patients had metastases in contralateral lung, requiring repeated radiotherapy.

Conclusion. ABC with higher lung volume and reduced PTV significantly decreased average toxic dose for lung and also for critical organs (esophagus, mediastinum, spinal cord), increased total absorbed dose, that may cause a significant increase of survival rates on patients with cardiovascular diseases.

KEY WORDS: stereotactic conformal radiotherapy, normal tissue radiotoxicity, short- and long-term radiation-induced complications, active breathing control, co-morbidity.

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