Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity

Abstract

AIM:To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during threedimensional conformal radiotherapy (3D-CRT). METHODS:We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria. RESULTS:Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ≥60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P = 0.0001<0.01). However, no grade 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P = 0.0001<0.01). CONCLUSION:Concurrent chemotherapy and the maximal esophageal point dose ≥60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT. INTRODUCTIONRadiotherapy (RT) can achieve good results in the treatment of non-small-cell lung cancer (NSCLC). The key is how to monitor the dose to critical normal tissues such as the heart, normal lung, and esophagus. Several factors can minimize the dose of RT to the esophagus, including proximity of the esophagus to midline tumors or mediastinal adenopathy, proximity of the esophagus to higher priority organs such as spinal cord and heart and relative paucity of information on the clinical and dosimetric predictors of radiation-induced esophageal injury.Clinicians familiar with RT planning are often forced to evaluate multiple plans that produce equivalent coverage of the target with variable sparing of critical structures. By our experience, the esophageal dose is not critically considered because the clinical and dosimetric variables predicting esophageal injury are not well characterized. The purpose of this investigation was to analyze the incidence of acute and late grade 3-5 esophageal injury in patients with NSCLC during three-dimensional conformal radiotherapy (3D-CRT) combined with or without chemotherapy (sequential or concurrent).

Dosimetric and Clinical Predictors of Acute Esophagitis in Lung Cancer Patients in Turkey Treated with Radiotherapy

“…They identified that simultaneous chemotherapy doubled the risk of AE (p=0.001). Others reported this rate as a 12-fold increase (Werner Wasik et al, 1999;Qiao et al, 2005;Caglar et al, 2010). In a series of 105 lung cancers, grade 3 AE was not seen in patients who received only RT; while the rate of grade 3 AE was reported to be 18% in the CRT group (p=0.001) (Werner Wasik et al, 2000).…”

“…This value is reported as 55 Gy by Singh et al (2003) in their series of 207 cases from a Western society and 60 Gy by Qiao et al (2005) in their series of 208 cases comprising a Far Eastern society.…”

Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

“…For esophageal toxicity, we chose to look at D2cc as several series have shown maximum doses to the esophagus to predict grade 3 esophagitis. [22][23][24][25] Furthermore, using maximum dose reduces the impact of variations in esophageal contours. While esophageal contours were standardized in the UM cohort, there are likely variations in the MROQC database.…”

Mediastinal Tumorlerde Radyoterapi

“…Olguların yalnızca %0.4-1'inde geç özefagus hasarına (örn. trakeoözefa-geal fistül, özefagus perforasyonu) bağlı ölüm bildirilmektedir (54,55 (57). Yüksek riskli olan hastalardaki bir diğer önemli nokta ise hayatı tehdit edebilecek olan komplikasyonların erken tanısı açısından klinisyenin uyanık olmasıdır.…”