Dosimetric predictors for acute esophagitis during radiation therapy for lung cancer: Results of a large statewide observational study

Paximadis, Peter; Schipper, Matthew J.; Matuszak, Martha M.; Feng, Mary; Jolly, Shruti; Boike, Thomas; Grills, I.S.; Kestin, Larry L.; Movsas, Benjamin; Griffith, Kent A.; Gustafson, G.; Moran, Jean M.; Nurushev, T; Radawski, Jeffrey D.; Pierce, Lori J.; Hayman, James A.

doi:10.1016/j.prro.2017.07.010

Cited by 21 publications

(21 citation statements)

References 29 publications

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“…In 2010, a Quantitative Analysis of Normal Tissue Effects in the Clinic report identified limiting mean esophageal dose to <34 Gy as the most significant factor for reducing the risk of grade 3+ RE, a planning goal also recommended in Radiation Therapy Oncology Group 0617 [11] , [60] . The dosimetric variables analyzed here, D2cc and gEUD, were selected due to recent promising results regarding their use in predicting RE [41] . D2cc is a parameter often used as surrogate for maximum point dose and is commonly used in other settings [61] , [62] .…”

Section: Discussionmentioning

confidence: 99%

“…More advanced approaches, including normal tissue complication probability modeling and anatomic correction, have shown unclear benefit [27] , [38] , [40] . More recently, a multi-institutional study evaluating multiple dose-volume metrics identified the maximum dose to 2 cubic cm (D2cc) and generalized equivalent uniform dose (gEUD) as superior parameters [41] .…”

Section: Introductionmentioning

confidence: 99%

“…We investigated combining pretreatment plasma cytokine data with dosimetric and clinical factors in an effort to improve prediction of RE in patients undergoing definitive radiotherapy for NSCLC. Dosimetric factors of D2cc and gEUD were selected due to recently published favorable results using these parameters [41] .…”

Section: Introductionmentioning

confidence: 99%

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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%

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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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“…This study also raises a new paradigm to consider in that radiation dose/volume constraints should not simply be based upon clinical toxicity alone, as in the past. 26 Rather, we should constantly be enhancing our radiation dose/volume parameters based upon the more sensitive and clinically meaningful impact that they have on our patients' QOL.…”

Section: Treatment Planning Implicationsmentioning

confidence: 99%

An Analysis of Clinical Toxic Effects and Quality of Life as a Function of Radiation Dose and Volume After Lung Stereotactic Body Radiation Therapy

Devpura

Feldman

Rusu

et al. 2021

Advances in Radiation Oncology

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“…The RTOG recommendation is to limit oesophagus mean dose to <34 Gy to the oesophagus for lung cancer treatment . A higher oesophageal dose may occur from lung cancer irradiation in some patients due to the proximity of tumour to the oesophagus; a few studies have used 34 Gy as a dose threshold to limit toxicity . Dose reports from other studies found a correlation from 30 Gy .…”

Section: Methodsmentioning

confidence: 99%

Radiation‐induced oesophagitis in breast cancer: Factors influencing onset and severity for patients receiving supraclavicular nodal irradiation

et al. 2019

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Aim The aim of this study was to determine dosimetric factors, such as mean dose and oesophageal length, which may influence the incidence and severity of oesophagitis in breast cancer patients receiving radiotherapy to the supraclavicular nodes. Methods This was a single‐arm prospective observational study. Toxicity grading was undertaken twice weekly to determine the onset of grade 2 oesophagitis in consecutive patients prescribed IMRT to the breast or chest wall and supraclavicular fossa (SCF) nodes. Recorded variables included mean and maximum doses to the oesophagus, oesophageal length and pharynx length within the treatment area. Multivariate logistic regression and Fishers’ exact test were used with a 0.05 significance level to compare the onset of grade 2 oesophagitis with these variables. Results A total of 77 patients were included in the study. Twenty‐four (31%) patients reported grade 2 oesophagitis. There was a higher incidence of grade 2 oesophagitis in patients receiving a mean oesophageal dose of ≥31 Gy compared to those receiving < 31 Gy (18/24 versus 6/24, respectively, P = 0.025). There was a significant difference in the onset of grade 2 toxicity in patients who had ≥ 1 cm of pharynx included in SCF fields compared with those with <1 cm (15/24 versus 9/24, respectively, P = 0.0116). The odds ratios for developing grade 2 oesophagitis were 3.2 (95% CI = 1.05–9.62, P = 0.04) for a mean dose of ≥31 Gy and 3.4 (95% CI = 1.19–9.5, P = 0.022) for ≥1 cm of pharynx in the SCF field. Conclusion By limiting the mean dose to the irradiated oesophagus to <31 Gy during the planning process and ensuring that <1 cm of pharynx is included in the radiation field, oesophageal toxicity may be minimised.

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Dosimetric predictors for acute esophagitis during radiation therapy for lung cancer: Results of a large statewide observational study

Abstract: In this study, we report the novel finding that gEUD and D2cc, rather than MD, were the most predictive dose metrics for severe esophagitis. To limit the estimated risk of grade ≥3 esophagitis to <5%, thresholds of 59.3 Gy and 68 Gy were identified for gEUD and D2cc, respectively.

Cited by 21 publications

References 29 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

An Analysis of Clinical Toxic Effects and Quality of Life as a Function of Radiation Dose and Volume After Lung Stereotactic Body Radiation Therapy

Radiation‐induced oesophagitis in breast cancer: Factors influencing onset and severity for patients receiving supraclavicular nodal irradiation

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