Mean esophageal radiation dose is predictive of the grade of acute esophagitis in lung cancer patients treated with concurrent radiotherapy and chemotherapy

Abstract

The intention of this research was to define the predictive factors for acute esophagitis (AE) in lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy. The data for 72 lung cancer patients treated with concurrent chemoradiotherapy between 2008 and 2010 were prospectively evaluated. Mean lung dose, mean dose of esophagus, volume of esophagus irradiated and percentage of esophagus volume treated were analysed according to esophagitis grades. The mean esophageal dose was associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P < 0.001). However, the mean lung dose and the volume of esophagus irradiated were not associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P = 0.50 and P = 0.41, respectively). The mean radiation dose received by the esophagus was found to be highly correlated with the duration of Grade 2 esophagitis (Spearman test, r = 0.82, P < 0.001). The mean dose of esophagus ≥28 Gy showed statistical significance with respect to AE Grade 2 or worse (receiver operating characteristic curve analysis, 95% CI, 0.929–1.014). In conclusion, the mean esophageal dose was significantly associated with a risk of esophageal toxicity in patients with lung cancer treated with concurrent radiotherapy and chemotherapy.

Predicting Radiation Esophagitis Using 18F-FDG PET During Chemoradiotherapy for Locally Advanced Non–Small Cell Lung Cancer

“…The incidence and timing of development of RE that we noted in our study population were similar to those previously reported in patients undergoing CRT. 5,15,18,19 We did not find any correlation between age, histologic findings, performance status, or sex and development of RE. We noted a significant difference in number of patients with grade 3 RE compared with the number of patients with grade 2, which has been noted in other studies 7 and would be in keeping with higher doses delivered close to the esophagus because of mediastinal disease.…”

“…1 Grade 3 RE will develop in approximately 18% of patients undergoing CRT 1,3 ; it is associated with severe morbidity and can necessitate supportive feeding and hospital admissions and can also potentially prolong treatment times and negatively affect overall survival. 4 Several dosimetric and volumetric factors have been suggested to be predictive of RE, including mean esophageal dose, 5 esophagus length, and volume of esophagus receiving greater than 50 Gy (V50) 6 or 60 Gy (V60), as is shown in the meta-analysis by Palma et al 3 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is established in staging lung cancers and has been shown to correlate with outcomes after CRT. 4,[7][8][9] Using FDG-PET to plan radiotherapy improves accuracy of contouring 10,11 and can aid in adaptive planning to boost regions of high or residual uptake.…”

Advances in dosimetry and biological predictors of radiation-induced esophagitis

“…V 55 Esoph in to 50% was the best cutoff point for acute esophagitis. Both Ozgen et al 21 and Huang et al 22 reported that D mean was significantly correlated with grade ≥2 RE. Palma et al 23 reported that V 60 was the best predictor of RE, while V 60 >17% conferred the higher risk of grade ≥3 RE.…”

Serum Alpha-2-Macroglobulin as an intrinsic radioprotective factor in patients undergoing thoracic radiation therapy

“…The high selection frequency of A2M in the model building process also confirms our primary correlative analyses linking A2M levels to esophagitis rates. Factors that have repeatedly shown significant correlation with esophagitis include V40-V60 6,37-40 (Vx: percentage volume receiving at least x Gy) and the mean esophageal dose [41][42][43] . Several authors have reported on the increased risk for high-grade esophagitis after sequential and especially concurrent chemo-RT in comparison to RT alone.…”