Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy

Belderbos, J.; Heemsbergen, Wilma D.; Hoogeman, M.; Pengel, Kenneth E.; Rossi, Maddalena; Lebesque, Joos V.

doi:10.1016/j.radonc.2005.03.021

Cited by 168 publications

(128 citation statements)

References 23 publications

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“…Normal tissue control probability (NTCP) was calculated using the BioSuite software, designed for radiobiological analysis (11). A LymanKutcher-Burman model was used to determine the probability of lung radiation pneumonitis (TD 50 =29.2 Gy, m=0.45, n=1, α/β=3 Gy) (12) and acute esophageal toxicity grade ≥2 (TD 50 =47 Gy, m=0.36, n=0.69, α/β=1.7 Gy) (13). A relative seriality model was instead used to calculate the probability of cardiac mortality (TD 50 =70.3 Gy, g=0.96, s=1, α/β=3 Gy) (14).…”

Section: Discussionmentioning

confidence: 99%

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

et al. 2016

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Background: Intensity modulated radiotherapy (IMRT) is routinely utilized in the treatment of locally advanced non-small cell lung cancer (NSCLC). RTOG 0617 found that overall survival was impacted by increased low (5 Gy) and intermediate (30 Gy) cardiac doses. We evaluated the impact of esophageal-sparing IMRT on cardiac doses with and without the heart considered in the planning process and predicted toxicity compared to 3D-conventional radiotherapy (3DCRT). Methods: Ten consecutive patients with N2 Stage III NSCLC treated to 60 Gy in 30 fractions, betweenFebruary 2012 and September 2014, were evaluated. For each patient, 3DCRT and esophageal-sparing IMRT plans were generated. IMRT plans were then created with and without the heart considered in the optimization process. To compare plans, the dose delivered to 95% and 99% of the target (D 95% and D 99% ), and doses to the esophagus, lung and heart were compared by determining the volume receiving X dose (V XGy ) and the normal tissue complication probability (NTCP) calculated. Results: IMRT reduced maximum esophagus dose to below 60 Gy in all patients and produced significant reductions to V 50Gy , V 40Gy and esophageal NTCP. The cost of this reduction was a non-statistically, nonclinically significant increase in low dose (5 Gy) lung exposure that did not worsen lung NTCP. IMRT plans produced significant cardiac sparing, with the amount of improvement correlating to the amount of heart overlapping with the target. When included in plan optimization, for selected patients further sparing of the heart and improvement in heart NTCP was possible. Conclusions: Esophageal-sparing IMRT can significantly spare the heart even if it is not considered in the optimization process. Further sparing can be achieved if plan optimization constrains low and intermediate heart doses, without compromising lung doses.

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Section: Discussionmentioning

confidence: 99%

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

et al. 2016

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“…Acute esophagitis is a very common complication of RT in thoracic malignancies and may cause dose-limiting toxicity that is reported in 5-100% of patients treated with toracic radiotherapy (Belderbos et al, 2005). The main clinical signs of acute radiation esophagitis are dysphagia and odynophagia.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical and dosimetric factors may be related to the incidence and severity of acute radiation esophagitis. These factors are: age (Ahn et al, 2005) tumor stage (Choy et al, 1998) , nodal stage (Belderbos et al, 2005), concurrent chemoirradiation (Choy et al, 1998), mean esophageal dose and maximal dose point (Etiz et al,…”

Section: Introductionmentioning

confidence: 99%

Oral Glutamine Supplementation Reduces Radiotherapy-induced Esophagitis in Lung Cancer Patients

Kanyılmaz¹,

Muge²,

A³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: The purpose of this study was to assess the the efficacy of oral glutamine (GLN) in prevention of acute radiation-induced esophagitis in patients with lung cancer and determine the predictive role of clinical and dosimetric parameters. Materials and Methods: Thirty-two patients diagnosed with lung cancer were studied prospectively. Sixteen patients (50%) received prophylactic powdered GLN orally in doses of 10g/8h. Patients were treated 2 Gy per fraction daily, 5 days a week. We evaluated the grading of esophagitis daily at the end of each fraction of each treatment day until a cumulative dose of 50 Gy was reached. The primary end point was radiation-induced esophagitis. Results: All patients tolerated GLN well. Toxicity grade, weight loss, serum cytokine levels and esophageal transit times exhibited statistically significant improvement in the GLN receiving group. GLN suppressed the inflammation related to the disease and treatment and reduced toxicity with statistical significance. Conclusions: This study suggests a benefical role of oral GLN use in prevention and/or delay of radiation-induced esophagitis, in terms of esophageal transit time and serum immunological parameters, as well as weight loss.

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“…When it occurs, AE often peaks in the first few weeks of a course of radiation therapy. [1][2][3] Patient-related, tumor-related, and treatment-related risk factors [3][4][5][6][7][8] that have been reported to be statistically associated with the incidence or severity of AE include age, tumor nodal stage, concurrent chemotherapy, and body mass index. Two recent reviews 9,10 summarized the dosimetric predictors.…”

Section: Introductionmentioning

confidence: 99%

“…Rose et al 9 systematically reviewed 18 published studies of patients with nonesmall cell lung cancer who had radiation-induced esophagitis. [3][4][5][6][7][11][12][13][14][15][16][17][18][19][20][21][22][23] Eleven studies specifically assessed AE, and the other studies assessed acute and chronic radiation-induced esophagitis together. Five dosimetric parameters were identified as predictive of AE with or without chemotherapy: mean esophageal dose (MED), maximal esophageal dose, percentage of esophagus volume receiving !20 Gy (V20), V35, and V60.…”

Section: Introductionmentioning

confidence: 99%

Independent Test of a Model to Predict Severe Acute Esophagitis

Huang

Robinson

Molotievschi

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Treatment planning factors are known to affect the risk of severe acute esophagitis during thoracic radiation therapy. We tested a previously published model to predict the risk of severe acute esophagitis on an independent data set. Methods and materials:The data set consists of data from patients who had recoverable treatment plans and received definitive radiation therapy for nonesmall cell carcinoma of the lung at a single institution between November 2004 and January 2010. Complete esophagus dose-volume and available clinical information was extracted using our in-house software. The previously published model was a logistic function with a combination of mean esophageal dose and use of concurrent chemotherapy. In addition to testing the previous model, we used a novel, machine learning-based method to build a maximally predictive model. Results: Ninety-four patients (81.7%) developed Common Terminology Criteria for Adverse Events, Version 4, Grade 2 or more severe esophagitis (Grade 2: n Z 79 and Grade 3: n Z 15). Univariate analysis revealed that the most statistically significant dose-volume parameters included percentage of esophagus volume receiving !40 to 60 Gy, minimum dose to the highest 20% of esophagus volume (D20) to D35, and mean dose. Other significant predictors included concurrent chemotherapy and patient age. The previously published model predicted risk effectively with a Spearman's rank correlation coefficient (r s ) of 0.43 (P < .001) with good calibration (HosmerLemeshow goodness of fit: P Z .537). A new model that was built from the current data set found the same variables, yielding an r s of 0.43 (P < .001) with a logistic function of 0.0853 Â mean esophageal dose [Gy] Lemeshow P Z .659. A novel preconditioned least absolute shrinkage and selection operator method yielded an average r s of 0.38 on 100 bootstrapped data sets. Conclusions: The previously published model was validated on an independent data set and determined to be nearly as predictive as the best possible two-parameter logistic model even though it overpredicted risk systematically. A novel, machine learning-based model using a bootstrapping approach showed reasonable predictive power.

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Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy

Cited by 168 publications

References 23 publications

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

Oral Glutamine Supplementation Reduces Radiotherapy-induced Esophagitis in Lung Cancer Patients

Independent Test of a Model to Predict Severe Acute Esophagitis

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