A Contralateral Esophagus-Sparing Technique to Limit Severe Esophagitis Associated With Concurrent High-Dose Radiation and Chemotherapy in Patients With Thoracic Malignancies

Al-Halabi, H.; Paetzold, P.; Sharp, G; Olsen, Christine; Willers, Henning

doi:10.1016/j.ijrobp.2015.03.018

Cited by 31 publications

(30 citation statements)

References 25 publications

(39 reference statements)

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“…The majority of patients analyzed in this work were treated with 3DCRT. Multiple studies have shown that the use of IMRT is associated with reduced rates of RE, although others have shown no improvement [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] . With increasing utilization of IMRT for NSCLC, it is possible that the generalizability of our results may be reduced.…”

Section: Discussionmentioning

confidence: 99%

“…Dose-escalated, twice-daily, and hyopfractionated radiotherapy courses increase risk [2] , [9] , [11] , [12] , [13] . Improved esophageal sparing with intensity-modulated radiotherapy (IMRT) has shown promise for reducing rates of grade 3+ RE compared to 3D-conformal (3DCRT), although this has not been consistent in all studies [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] . A multitude of dosimetric factors predictive of RE have been described, including mean esophageal dose, maximum esophageal dose, and various doses to esophageal surface area, length, and volumes (including total, infield, and relative volumes) [8] , [9] , [10] , [14] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of Radiation Esophagitis in Non–Small Cell Lung Cancer Using Clinical Factors, Dosimetric Parameters, and Pretreatment Cytokine Levels

Hawkins

Boonstra

Hobson

et al. 2018

Translational Oncology

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Radiation esophagitis (RE) is a common adverse event associated with radiotherapy for non–small cell lung cancer (NSCLC). While plasma cytokine levels have been correlated with other forms of radiation-induced toxicity, their association with RE has been less well studied. We analyzed data from 126 patients treated on 4 prospective clinical trials. Logistic regression models based on combinations of dosimetric factors [maximum dose to 2 cubic cm (D2cc) and generalized equivalent uniform dose (gEUD)], clinical variables, and pretreatment plasma levels of 30 cytokines were developed. Cross-validated estimates of area under the receiver operating characteristic curve (AUC) and log likelihood were used to assess prediction accuracy. Dose-only models predicted grade 3 RE with AUC values of 0.750 (D2cc) and 0.727 (gEUD). Combining clinical factors with D2cc increased the AUC to 0.779. Incorporating pretreatment cytokine measurements, modeled as direct associations with RE and as potential interactions with the dose-esophagitis association, produced AUC values of 0.758 and 0.773, respectively. D2cc and gEUD correlated with grade 3 RE with odds ratios (ORs) of 1.094/Gy and 1.096/Gy, respectively. Female gender was associated with a higher risk of RE, with ORs of 1.09 and 1.112 in the D2cc and gEUD models, respectively. Older age was associated with decreased risk of RE, with ORs of 0.992/year and 0.991/year in the D2cc and gEUD models, respectively. Combining clinical with dosimetric factors but not pretreatment cytokine levels yielded improved prediction of grade 3 RE compared to prediction by dose alone. Such multifactorial modeling may prove useful in directing radiation treatment planning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of Radiation Esophagitis in Non–Small Cell Lung Cancer Using Clinical Factors, Dosimetric Parameters, and Pretreatment Cytokine Levels

Hawkins

Boonstra

Hobson

et al. 2018

Translational Oncology

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“…In particular, patients treated with a compromised PTV may reveal meaningful changes in quality of life that would not have otherwise been recorded as a grade II toxicity requiring medical intervention. Quite promisingly, in a contralateral esophageal-sparing technique, 20 curative-intent patients experienced no grade 3 adverse, 4 patients recorded a grade 2 adverse event, and 11 patients recorded a grade 1 adverse event [ 3 ]. Given the limited sample size and follow-up in this cohort, further research is required to assess whether such a strategy is generalizable and/or feasible in the broader patient population.…”

Section: Discussionmentioning

confidence: 99%

“…While IMRT is not routinely used in the palliative lung radiotherapy setting, it could be employed to minimize dose to the esophagus, which would typically receive the full treatment dose in a POP beam arrangement delivered in the common scenario of centrally located lung cancer and/or bulky mediastinal lymphadenopathy causing symptoms. A recent study described and reported the clinical IMRT treatment approach in 20 curative-intent NSCLC patients whereby the contralateral esophagus wall was spared without compromising planning target volume (PTV) coverage with favourable results [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Intentional avoidance of the esophagus using intensity modulated radiation therapy to reduce dysphagia after palliative thoracic radiation

2017

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BackgroundPalliative thoracic radiotherapy is an effective technique to alleviate symptoms of disease burden in advanced-stage lung cancer patients. Previous randomized controlled studies demonstrated a survival benefit in patients with good performance status at radiation doses of 35Gy10 or greater but with an increased incidence of esophagitis. The objective of this planning study was to assess the potential impact of esophageal-sparing IMRT (ES-IMRT) compared to the current standard of care using parallel-opposed pair beams (POP).MethodsIn this study, 15 patients with lung cancer treated to a dose of 30Gy in 10 fractions between August 2015 and January 2016 were identified. Radiation treatment plans were optimized using ES-IMRT by limiting the max esophagus point dose to 24Gy. Using published Lyman-Kutcher-Burman normal tissue complication probabilities (LKB-NTCP) models, both plans were evaluated for the likelihood of esophagitis (≥ grade 2) and pneumonitis (≥ grade 2).ResultsUsing ES-IMRT, the median esophageal and lung mean doses reduced from 16 and 8Gy to 7 and 7Gy, respectively. Using the LKB models, the theoretical probability of symptomatic esophagitis and pneumonitis reduced from 13 to 2%, and from 5 to 3%, respectively. The median normalize total dose (NTD mean) accounting for fraction size for the GTV and PTV of the clinically approved POP plans compared to the ES-IMRT plans were similar.ConclusionAdvanced radiotherapy techniques such as ES-IMRT may have clinical utility in reducing treatment-related toxicity in advanced lung cancer patients. Our data suggests that the rate of esophagitis can be reduced without compromising local control.

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“…The evaluation for the acute radiation-induced esophageal and/or pulmonary injury was based on the standards proposed by the Radiation Therapy Oncology Group (RTOG) in 1997 ( 11 ). The lymph node metastasis was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1).…”

Section: Methodsmentioning

confidence: 99%

Hypofractionated Radiotherapy in Combination With Chemotherapy Improves Outcome of Patients With Esophageal Carcinoma Tracheoesophageal Groove Lymph Node Metastasis

Wang

Jiang³

et al. 2020

Front. Oncol.

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This study investigated the efficiency and safety of hypofractionated radiotherapy (HFR) combined with paclitaxel chemotherapy for the treatment of postsurgery tracheoesophageal groove lymph node (TGLN) metastasis in patients with esophageal cancer (EC). Fifty-three EC patients with TGLN metastasis after surgery admitted to the Yancheng Third People’s Hospital from January 2013 to June 2015 were included in this study. They were randomly divided into the HFR group ( n = 25) and conventional fractioned radiotherapy (CFR) group ( n = 28) based on the random grouping method. Patients in the HFR group received treatment with radiation of 60 Gy (5 fractions per week, total 20 fractions) combined with paclitaxel chemotherapy at a dose of 50 mg once per week for 4 weeks. Patients in the CFR group received radiation of 60 Gy (5 fractions per week, total 30 fractions) combined with paclitaxel chemotherapy at a dose of 50 mg once per week for 6 weeks. The adverse events and treatment outcomes in these two groups were analyzed. It was found that there was no significant difference in the incidence of radiation esophagitis in the HFR group compared with that of the CFR group (grades 3–4, 44.0 vs. 25.0%; P = 0.149). There was no statistical difference in the incidence of radiation pneumonitis between these two groups (grades 3–4, 16.0 vs. 7.1%; P = 0.314). No statistical difference was noticed in complete response (CR), partial response (PR), and no response (NR) between these two groups. The median overall survival (OS) in the HRF group was significantly longer compared with that of the CRF group (24.2 months (95% CI, 16.2–32.1 months) vs. 11.8 months (95% CI, 9.2–14.4 months); P = 0.024). Our results indicated that the combination of HFR and chemotherapy improved the prognosis of EC patients with TGLN metastasis with no increased adverse events.

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A Contralateral Esophagus-Sparing Technique to Limit Severe Esophagitis Associated With Concurrent High-Dose Radiation and Chemotherapy in Patients With Thoracic Malignancies

Cited by 31 publications

References 25 publications

Prediction of Radiation Esophagitis in Non–Small Cell Lung Cancer Using Clinical Factors, Dosimetric Parameters, and Pretreatment Cytokine Levels

Prediction of Radiation Esophagitis in Non–Small Cell Lung Cancer Using Clinical Factors, Dosimetric Parameters, and Pretreatment Cytokine Levels

Intentional avoidance of the esophagus using intensity modulated radiation therapy to reduce dysphagia after palliative thoracic radiation

Hypofractionated Radiotherapy in Combination With Chemotherapy Improves Outcome of Patients With Esophageal Carcinoma Tracheoesophageal Groove Lymph Node Metastasis

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