Dosimetric predictors of radiation esophagitis in patients treated for non-small-cell lung cancer with carboplatin/paclitaxel/radiotherapy

Hirota, Saeko; Tsujino, Kayoko; Endo, Masahiro; Kotani, Yoshikazu; Satouchi, Miyako; Kado, Tetsuji; Hishikawa, Yoshio; Obayashi, Kayoko; Takada, Yoshiki; Kono, Michio; Abe, Mitsuyuki

doi:10.1016/s0360-3016(01)01648-0

Cited by 67 publications

(27 citation statements)

References 10 publications

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“…Previous studies have identified several clinical and dosimetric factors that are related to radiation-induced esophageal toxicity (ET) in patients with lung cancer (Werner-Wasik et al 2000;Hirota et al 2001a;Singh et al 2003;Bradley et al 2004;Patel et al 2004;Ahn et al 2005;Kim et al 2005;Takeda et al 2005) (Table 6). However, there have been few studies that have examined these factors for ET in patients with other thoracic malignancies, though several authors have reported on ET in patients with intra-thoracic malignancies (Hirota et al 2001b;Perez et al 2002;Chen et al 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Previous researches reported the following dosimetric predictors for AET: the percentage of esophageal volume receiving > 45 Gy (V45), V50, V60; the length of the esophagus in the treatment field; the maximal esophageal point dose; hyper-fractionated radiotherapy; and the esophageal surface area receiving 55 Gy (A55) (Werner-Wasik et al 2000;Hirota et al 2001a;Singh et al 2003;Bradley et al 2004;Patel et al 2004;Ahn et al 2005;Kim et al 2005). Most of these predictors were related to AET Radiation Therapy Oncology Group (RTOG) criteria grade 2-3 or worse (Cox et al 1995).…”

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confidence: 99%

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Predictive Factors for Acute Esophageal Toxicity in Thoracic Radiotherapy

Takeda

Nemoto

Saito

et al. 2006

Tohoku J. Exp. Med.

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Acute esophageal toxicity (AET) is a common complication and dose-limiting toxicity in thoracic radiotherapy. Previous studies demonstrated several clinical and dosimetric parameters of AET in patients with lung cancer. However, there are few reports dealing with these variables in intra-thoracic malignancies, including lung cancer and other thoracic malignancy. The purpose of this study was to evaluate the clinical and dosimetric factors associated with AET in patients with intra-thoracic malignancies. We examined 61 patients with intra-thoracic malignancies treated with radiotherapy: 34 patients with non-small-cell lung cancer (55%), 9 cases with small-cell lung cancer (15%), 7 cases with thymic cancer (11%), 4 thymomas (7%), 2 malignant lymphomas (3%), one seminoma (2%), one liposarcoma (2%), and 3 cases of other malignancies (5%). Radiotherapy was performed with a median dose of 60 Gray (Gy) (range 40-67 Gy). AET was graded according to the Radiation Therapy Oncology Group (RTOG) criteria. The following parameters were analyzed with respect to associations with AET by univariate and multivariate analyses: age, gender, thoracic surgery before radiotherapy, concurrent chemotherapy, duration of radiotherapy, maximum esophageal dose, mean esophageal dose, and percentage of esophageal volume receiving from 10 Gy (V10) to 65 Gy (V65), in 5-Gy increments. 43 patients (70%) developed AET: 36 patients (59%) with AET of RTOG Grade 1, 7 patients (11%) with Grade 2, and no patients (0%) with Grade 3 or worse. On multivariate analysis, V35 > 30% was the most statistically significant factor associated with mild AET ( p = 0.013). Our findings provide a better understanding of the factors related to AET, and might be useful in designing a treatment plan to prevent severe esophageal toxicity.acute esophageal toxicity; radiotherapy; predictions; thoracic neoplasms

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Predictive Factors for Acute Esophageal Toxicity in Thoracic Radiotherapy

Takeda

Nemoto

Saito

et al. 2006

Tohoku J. Exp. Med.

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“…Previous studies on acute radiation esophagitis have revealed various DVH predictors (18)(19)(20)(21)(22)(23)(24)(25)(26). However, it is difficult to identify the best predictive DVH threshold for acute radiation esophagitis because those DVH values were reported with various endpoints (e.g., G 1, G 2, or G 3).…”

Section: Discussionmentioning

confidence: 99%

“…In order to reduce such toxicities, involved field radiotherapy (IFRT) without an elective nodal irradiation (ENI) has been developed (8)(9), and it has been demonstrated to be capable of dose escalation without increasing toxicities (10)(11)(12)(13)(14)(15). Predictive analyses of radiation pneumonitis and esophagitis by using a dose-volume histogram (DVH) have been investigated in many studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26); however, predictive values derived from a standard dose of 60 Gy with an ENI might not be applicable to high-dose IFRT for stage III NSCLC (7). We previously reported that 72 Gy in 36 fractions is the optimal dose that could be attained with maintenance of the normal tissue constraints (14).…”

Section: Introductionmentioning

confidence: 99%

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

Kuroda

Sekine

Sumi

et al. 2013

Technol Cancer Res Treat

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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-

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“…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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Dosimetric predictors of radiation esophagitis in patients treated for non-small-cell lung cancer with carboplatin/paclitaxel/radiotherapy

Cited by 67 publications

References 10 publications

Predictive Factors for Acute Esophageal Toxicity in Thoracic Radiotherapy

Predictive Factors for Acute Esophageal Toxicity in Thoracic Radiotherapy

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

Independent Test of a Model to Predict Severe Acute Esophagitis

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