Association of oesophageal radiation dose volume metrics, neutropenia and acute radiation oesophagitis in patients receiving chemoradiotherapy for non-small cell lung cancer

Abstract

IntroductionThe relationship between oesophageal radiation dose volume metrics and dysphagia in patients having chemoradiation (CRT) for non-small cell lung cancer (NSCLC) is well established. There is also some evidence that neutropenia is a factor contributing to the severity of oesophagitis. We retrospectively analysed acute radiation oesophagitis (ARO) rates and severity in patients with NSCLC who received concurrent chemotherapy and high dose radiation therapy (CRT). We investigated if there was an association between grade of ARO, neutropenia and radiation dose volume metrics.Material and methodsPatients with NSCLC having concurrent CRT who had RT dose and toxicity data available were eligible. Exclusion criteria included previous thoracic RT, treatment interruptions and non-standard dose regimens. RT dosimetrics included maximum and mean oesophageal dose, oesophagus dose volume and length data.ResultsFifty four patients were eligible for analysis. 42 (78 %) patients received 60 Gy. Forty four (81 %) patients received carboplatin based chemotherapy. Forty eight (89 %) patients experienced ARO ≥ grade 1 (95 % CI: 78 % to 95 %). ARO grade was associated with mean dose (rs = 0.27, p = 0.049), V20 (rs = 0.31, p = 0.024) and whole oesophageal circumference receiving 20 Gy (rs = 0.32 p = 0.019). In patients who received these doses, V20 (n = 51, rs = 0.36, p = 0.011), V35 (n = 43, rs = 0.34, p = 0.027) and V60 (n = 25, rs = 0.59, P = 0.002) were associated with RO grade. Eleven of 25 (44 %) patients with ARO ≥ grade 2 also had ≥ grade 2 acute neutropenia compared with 5 of 29 (17 %) patients with RO grade 0 or 1 (p = 0.035).ConclusionIn addition to oesophageal dose-volume metrics, neutropenia may also be a risk factor for higher grades of ARO.

Acute radiation oesophagitis associated with 2‐deoxy‐2‐[18F]fluoro‐d‐glucose uptake on positron emission tomography/CT during chemo‐radiation therapy in patients with non‐small‐cell lung cancer

“…Although a greater proportion of patients with neutropaenia grade ≥2 developed grade ≥2 oesophagitis (80%) than patients who did not experience neutropaenia (38%), this was not statistically significant. However, it is not consistent with our previous study of oesophagitis and neutropaenia, and work by De Ruysscher et al (2007), where an association between these toxicities was observed . The lack of a statistically significant association in the current study is likely due to the small sample size of 40 patients.…”

“…(2016) reported no difference in O max between patients with G0 vs G ≥ 1 ARO, whereas we observed a significant difference in O max between G0–1 and G2–3 severity groups ( P = 0.0061). Our data reporting associations between radiation dose and ARO are consistent with previous studies by our own team and others; O max , O mean and the volume of oesophagus receiving ≥ 35 Gy were associated with clinically significant ARO …”

“…However, it is not consistent with our previous study of oesophagitis and neutropaenia, and work by De Ruysscher et al (2007), where an association between these toxicities was observed. 22,23 The lack of a statistically significant association in the current study is likely due to the small sample size of 40 patients. Further research to explore this relationship is warranted in the future.…”

“…Our data reporting associations between radiation dose and ARO are consistent with previous studies by our own team and others; O max , O mean and the volume of oesophagus receiving ≥ 35 Gy were associated with clinically significant ARO. 1,5,7,22 Although a greater proportion of patients with neutropaenia grade ≥2 developed grade ≥2 oesophagitis (80%) than patients who did not experience neutropaenia (38%), this was not statistically significant. However, it is not consistent with our previous study of oesophagitis and neutropaenia, and work by De Ruysscher et al (2007), where an association between these toxicities was observed.…”

Radiation Esophagitis in a Patient with Oral Carcinoma and Bone Metastasis

“…Associations between radiation dose and clinically significant acute radiation esophagitis have been reported when the esophagus receives ≥35 Gy [ 9 , 11 ]. In addition to esophageal dose-volume metrics, neutropenia may also be a risk factor for higher grades of acute radiation esophagitis [ 12 ]. Both concurrent chemoradiotherapy (CRT) and the volume that receives at least 35 Gy are predictors of acute esophageal toxicity [ 13 ].…”