Acute Esophagus Toxicity in Lung Cancer Patients After Intensity Modulated Radiation Therapy and Concurrent Chemotherapy

Kwint, Margriet; Uyterlinde, Wilma; Nijkamp, Jasper; Chen, Chun; Bois, Josien de; Sonke, Jan‐Jakob; Heuvel, Michel van den; Knegjens, J.; Herk, Marcel van; Belderbos, J.

doi:10.1016/j.ijrobp.2012.03.027

Cited by 60 publications

(43 citation statements)

References 14 publications

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“…A prospective study from the Netherlands Cancer Institute of 139 patients with inoperable NSCLC treated with IMRT and concurrent chemotherapy aimed to analyze predictive parameters for AET with the dose effect relationship between AET and dose volume parameters investigated (14). Before the introduction of IMRT, 3D-conformal radiotherapy (3DCRT) was the standard technique used for radical treatment.…”

Section: Acute Esophagus Toxicitymentioning

confidence: 99%

“…The treatment planning esophagus constraint at that time was the length of the esophagus ≤12 cm. Because this constraint was found insufficient in patients treated with 3DCRT and concurrent chemotherapy, a derived V35 (relative volume of the esophagus receiving more than 35 Gy) model was scaled (14). However, with IMRT dose-distributions and dose-volume-parameters for the esophagus having changed, it was concluded that V35 was no longer sufficient as well.…”

Section: Acute Esophagus Toxicitymentioning

confidence: 99%

“…However, with IMRT dose-distributions and dose-volume-parameters for the esophagus having changed, it was concluded that V35 was no longer sufficient as well. It was revealed that in IMRT the relative volume of the esophagus treated with 50 Gy (V50) was a more predictive parameter for AET (14). In addition to these findings patient and treatment characteristics were analyzed in relation to AET, including the V50 model.…”

Section: Acute Esophagus Toxicitymentioning

confidence: 99%

“…This knowledge was used for initiating proactive supportive care management, patient education and the recalculation of RT restraints (13)(14)(15) …”

Section: Introductionmentioning

confidence: 99%

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Overcoming toxicity-challenges in chemoradiation for non-small cell lung cancer

Uyterlinde

2016

Transl. Lung Cancer Res.

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Concurrent chemoradiation (CCRT) is the treatment of choice for locally advanced non-small cell lung cancer (NSCLC) with a modest survival benefit over sequential chemoradiation or radiotherapy (SCRT) alone. However, this benefit is at the cost of increasing acute toxicity such as esophagitis. Previous analysis revealed several predictive parameters in dose-volume and patient characteristics which helped us to identify those patients at risk for severe esophagus toxicity. As a result, supportive care interventions including individualized patient information, dietary guidance, adequate medication, hydration and tubefeeding could be initiated. This paper discusses the challenges in overcoming chemoradiation induced acute esophageal toxicity (AET).

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Section: Acute Esophagus Toxicitymentioning

confidence: 99%

Section: Acute Esophagus Toxicitymentioning

confidence: 99%

Section: Acute Esophagus Toxicitymentioning

confidence: 99%

“…This knowledge was used for initiating proactive supportive care management, patient education and the recalculation of RT restraints (13)(14)(15) …”

Section: Introductionmentioning

confidence: 99%

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Overcoming toxicity-challenges in chemoradiation for non-small cell lung cancer

Uyterlinde

2016

Transl. Lung Cancer Res.

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“…2 A recent meta-analysis showed that hyperfractionated or accelerated radiotherapy (RT) schedules improve survival rates;…”

Section: Introductionmentioning

confidence: 99%

Simultaneously modulated accelerated radiation therapy reduces severe oesophageal toxicity in concomitant chemoradiotherapy of locally advanced non-small-cell lung cancer

Chajon¹,

Bellec²,

Castelli³

et al. 2015

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Objective: The aim of this study was to evaluate the potential of simultaneously modulated accelerated radiation therapy (SMART) to reduce the incidence of severe acute oesophagitis in the treatment of unresectable locally advanced non-small-cell lung cancer (LANSCLC). Methods: 21 patients were treated with SMART and concomitant platinum-based chemotherapy. The prescribed doses were limited to 54 Gy at 1.8 Gy per day to the zones of presumed microscopic extent while simultaneously maintaining doses of 66 Gy at 2.2 Gy per day to the macroscopic disease. The whole treatment was delivered over 30 fractions and 6 weeks. . With a median follow-up of 18 months (6-33 months), the 1-year local control rate was 70% and the disease-free survival rate was 47%. Conclusion: SMART reduces the incidence of severe oesophagitis and improves the whole dosimetric predictors of toxicity for the lung, heart and spine. Advances in knowledge: Our study shows that SMART optimizes the therapeutic ratio in the treatment of LANSCLC, opening a window for dose intensification. INTRODUCTIONConcurrent chemoradiotherapy is the standard of care for the treatment of unresectable locally advanced non-smallcell lung cancer (LANSCLC). 1 Acute oesophageal toxicity (AET) is the main acute limiting toxicity related to this approach, and is responsible for weight loss, insertion of tube feeding, hospital admissions and treatment discontinuation. A recent meta-analysis showed that hyperfractionated or accelerated radiotherapy (RT) schedules improve survival rates;3 however, when chemotherapy is associated concomitantly with these schedules, the incidence of severe oesophagitis of around 22% remains a subject of concern. 4 In the RT planning process, the delineation of target volumes to be treated is an obligatory step. The gross demonstrable disease is named gross tumour volume (GTV) and encompasses the primary tumour and the metastatic lymph nodes identified by the endoscopic and radiologic examinations. The microscopic tumour spread, outside of what can be visualized in a particular imaging modality, is named clinical target volume (CTV) and corresponds to a volume of tissue surrounding the primary tumour and the lymph node stations considered at risk of failure. 5 In the standard technique of RT, a homogeneous dose of 66 Gy at 2 or 1.8 Gy per fraction and per day is delivered to the GTV and CTV. In contrast to this standard technique, simultaneously modulated accelerated radiation therapy (SMART) is a technique delivering 66 Gy by using high fraction doses (2.2 Gy per fraction) to the GTV simultaneously with standard fraction doses (1.8 Gy per fraction) to regions of presumed microscopic extent (CTV), devised in such a manner that the biologically effective GTV dose is equivalent to 70 Gy delivered by conventional (2 Gy per fraction) fractionated RT. This regimen is delivered over 6 weeks, representing a moderate acceleration over a standard course. As proved in head and neck cancer, this technique lead to a moderate GTV dose acceleration without inc...

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Machine learning algorithms for outcome prediction in (chemo)radiotherapy: An empirical comparison of classifiers

et al. 2018

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Random forest and elastic net logistic regression yield higher discriminative performance in (chemo)radiotherapy outcome and toxicity prediction than other studied classifiers. Thus, one of these two classifiers should be the first choice for investigators when building classification models or to benchmark one's own modeling results against. Our results also show that an informed preselection of classifiers based on existing datasets can improve discrimination over random selection.

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Acute Esophagus Toxicity in Lung Cancer Patients After Intensity Modulated Radiation Therapy and Concurrent Chemotherapy

Cited by 60 publications

References 14 publications

Overcoming toxicity-challenges in chemoradiation for non-small cell lung cancer

Overcoming toxicity-challenges in chemoradiation for non-small cell lung cancer

Simultaneously modulated accelerated radiation therapy reduces severe oesophageal toxicity in concomitant chemoradiotherapy of locally advanced non-small-cell lung cancer

Machine learning algorithms for outcome prediction in (chemo)radiotherapy: An empirical comparison of classifiers

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