Acute Radiation Esophagitis Caused by High-Dose Involved Field Radiotherapy with Concurrent Cisplatin and Vinorelbine for Stage III Non-small Cell Lung Cancer

Abstract

Purpose of this study is to obtain dose-volume histogram (DVH) predictors and threshold values for radiation esophagitis caused by high-dose involved field radiotherapy (IFRT) with concurrent chemotherapy in patients with stage III non-small cell lung cancer (NSCLC).Thirty-two patients treated by 66 Gy/33 Fr, 72 Gy/36 Fr, and 78 Gy/39 Fr thoracic radiotherapy without elective nodal irradiation plus concurrent cisplatin and vinorelvine were reviewed.Acute radiation esophagitis was evaluated according to common terminology criteria for adverse events version 4.0, and correlations between grade 2 or worse radiation esophagitis and DVH parameters were investigated. Grade 0-1, 2, 3, and 4-5 of radiation esophagitis were seen in 11 (34.4%), 20 (62.5%), 1 (3.1%), and 0 (0%) of the patients, respectively.Multivariate analysis revealed that whole esophagus V35 is a predictor of radiation esophagi-

Revisiting the dose constraints for head and neck OARs in the current era of IMRT

“…In the study by Kuroda et al keeping esophagus V35 ≤20% was associated with a considerably lower risk of esophagitis, which is more conservative than the QUANTEC V35 constraint. [46] In two separate reports, keeping the esophagus V50 <11%[49] or <50%[48] was identified as the optimal cutoff points for grade ≥2 or ≥3 esophagitis, respectively, which agrees reasonably well with the QUANTEC constraint. In a cohort of lung cancer patients treated with SBRT, keeping the esophagus D 5cc ≤26.3 GyBED 10 or max dose ≤52.9 GyBED 10 was associated with <20% risk of grade ≥2 esophagitis.…”

“…Thus, differences in patient characteristics, treatment setup and systemic therapy should be considered when using these dose-volume constraints to inform HNC OAR sparing. Acute esophagitis is typically assessed by physician-scoring using CTCAE[46–48, 51, 52] and EORTC/RTOG[49, 53–55] scales, although one study reported on patient-reported esophagitis based on EORTC QLQ-C30. [56]…”

Advances in dosimetry and biological predictors of radiation-induced esophagitis

“…V 50 was also the significant predictor for RE ≥grade 3 in the study by Kwint et al 4 Zhang et al 19 demonstrated that, in CCRT, V 40 was the significant factor associated with grade ≥2 RE (33.3% as V 40 <23% vs 89.1% as V 40 ≥23%) and V 50 was significantly correlated with grade 3 RE (6.7% as V 50 <26.5% vs 38.7% as V 50 ≥26.5%). Kuroda et al 5 revealed that V 35 was the only dosimetric predictor for grade ≥2 RE on multivariate analysis. Caglar et al 20 found that D mean and V 45 –V 60 were significantly associated with the risk of grade ≥3 RE.…”

“…Nineteen studies graded RE using RTOG criteria, while one study used the common toxicity criteria 4 and another used the common terminology criteria. 5 We summarized the results from five aspects as below.…”

Developing Dosiomics Models for the Prediction of Postoperative Radiotherapy-Induced Esophagitis in Patients with Non-Small Cell Lung Cancer

“…Several dosimetric factors were identi ed as predictors of RE including mean oesophageal dose (Dmean) [3] and volume of the oesophagus (Vx) receiving greater than 35 Gy (V35) [4], 40 Gy (V40) [5], 50 Gy (V50) [5,6], and 60 Gy (V60). Dosimetric factors [7,8] contain only partial dose distribution information.…”