Risk of radiation pneumonitis in patients receiving taxane-based trimodality therapy for locally advanced esophageal cancer

Abstract

Purpose There are limited data regarding clinical and treatment factors associated with radiation pneumonitis (RP) in patients receiving Taxane-based tri-modality therapy for esophageal cancer. The purpose of this study was to identify predictors of RP in patients undergoing tri-modality therapy. Materials and Methods We retrospectively reviewed patients undergoing chemoradiation followed by esophagectomy between 2006-2011. The association between clinical and dosimetric factors with RP was assessed using Chi-square test and Mann-Whitney U test. Multivariable (MVA) regression was used to assess the relationship between grade 2+ RP and clinical/dosimetric factors. Receiver operator curves were generated to identify threshold doses for RP. Results A total of 139 patients were included; 19 (13.7%) patients experienced grade 2+ RP. Patients with upper/middle thoracic tumors (p=0.038) and receiving higher radiation doses (p=0.038) were more likely to develop grade 2+ RP. There was no association between taxane-based therapy and grade 2+ RP (p=0.728). The total lung V5 (p<0.001), V10 (p<0.001), V20 (p<0.001), and V30 (p<0.001) were associated with an increased risk of grade 2+ RP. On MVA, the lung V5 (OR 1.101 95% CI 1.1014-1.195) and V20 (OR 1.149 95% CI 1.1015-1.301) remained associated with grade 2+ RP. A V5≤65% and V20≤ 25% were identified as optimal thresholds for increased grade 2+ RP. Conclusions Dosimetric parameters are strong predictors of symptomatic RP in patients undergoing tri-modality therapy for esophageal cancer. Mitigating the risk of RP in these patients should be an important consideration during treatment planning.

Fixed‐jaw technique to improve IMRT plan quality for the treatment of cervical and upper thoracic esophageal cancer

“…Tanabe et al performed a retrospective study of 86 EC patients undergoing definitive chemoradiotherapy, and found that the V 5Gy and V 10Gy values were the only factors significantly correlated with grade 2 or higher RP . Similarly, Shaikh et al also reported that V 5Gy and V 10Gy were strong predictors of symptomatic RP in a cohort of 139 EC patients treated with chemoradiotherapy and concluded that minimizing the low dose spread to the lung can decrease the risk of RP for these patients . In this study, the FJT plans significantly reduced the volume of the lung treated at each dose level (5–40 Gy), especially below 13 Gy.…”

“…However, IMRT is generally associated with a larger volume of low‐dose spread to normal tissues, in part due to the transmitted radiation through the multileaf collimator (MLC) . Clinical studies have found that the volumes of the lung receiving low doses were strongly associated with the incidence of radiation pneumonitis (RP), which is a major concern for EC patients receiving radiotherapy. It may not only cause serious pulmonary injury but also limit dose escalation strategies .…”

Clinical Application of a Hybrid RapidArc Radiotherapy Technique for Locally Advanced Lung Cancer

“…2 The limitations of VMAT and IMRT are especially concerning when treating lung tumors because large volumes of low-dose radiation increase the risk of pneumonitis and esophagitis. 7,8,20,21 IMRT has shown reduced rates of pneumonitis compared to 3D-CRT. 22,23 The Radiation Therapy Oncology Group (RTOG) 0617 trial showed significantly higher rates of severe pneumonitis in patients treated with 3D-CRT compared to IMRT (7.9% vs 3.5%, P ¼ .046), and the V20 may be more predictive of the risk of pneumonitis than the V5.…”

“…Seven of 11 RA plans had an esophageal V60 >17%. Shaikh et al reported that the risk of radiation pneumonitis is significantly increased with a lung V5 >65% and a V20 >25%, 21 while secondary analysis of RTOG 0617 indicates that V20 is more predictive of radiation pneumonitis risk. 22 In the H-RA and RA plans in our study, 9 of 11 had a V20 !25%, whereas the V20 was !25% for all 11 of the 3D-CRT plans.…”

Efficacy of virtual block objects in reducing the lung dose in helical tomotherapy planning for cervical oesophageal cancer: a planning study

“…However, our previous study reported that using HT for CEC increases low-dose radiation in the lung compared to that by 3DCRT due to lateral directional beamlets that traverse both sides of the lung during gantry rotations [ 10 ]. Although the rate of radiation pneumonitis (RP) in CEC has not been determined, it is a common adverse event in thoracic oesophageal cancer, and low-dose irradiated lung volumes such as V5 and V10 have been reported as important predictive factors for RP [ 11 – 13 ]. An HT function termed “block plan” can restrict beamlets by using a virtual block during computation of dose optimization and may aid in dose reduction.…”