Predicting Esophagitis After Chemoradiation Therapy for Non-Small Cell Lung Cancer: An Individual Patient Data Meta-Analysis

Palma, David A.; Senan, Suresh; Oberije, Cary; Belderbos, J.; Dios, Núria Rodriguez de; Bradley, Jeffrey D.; Barriger, R. Bryan; Moreno-Jiménez, Marta; Kim, Tae Hyun; Ramella, Sara; Everitt, Sarah; Rengan, Ramesh; Marks, Lawrence B.; Ruyck, Kim De; Warner, Andrew; Rodrigues, George

doi:10.1016/j.ijrobp.2013.07.029

Cited by 152 publications

(147 citation statements)

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“…Although concurrent chemotherapy improves survival by approximately 5% at 5 years, it also significantly increases the risk of toxicity (2). Among the potential toxicities, pneumonitis and esophagitis are the best understood and for these reliable dose-volume constraints are routinely considered during radiotherapy planning (3,4).…”

Section: Introductionmentioning

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: Introductionmentioning

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 radiation-induced esophageal damage (ARIED) or acute esophagitis can be a dose-limiting factor during head and neck cancer and lung cancer RT. [2][3][4][5][6][7] Acute radiation-induced damages appear within three months after RT, and late radiation-induced damages occur more than three months postirradiation. 8,9 ARIED arises in most patients treated with lung and thoracic RT since the gastrointestinal tract is often close to the primary tumor or tumorbearing lymph nodes.…”

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confidence: 99%

Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models

et al. 2018

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"Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models," J. Biomed. Opt. 23(4), 046004 (2018), doi: 10.1117/1.JBO.23.4.046004. Abstract. Lung cancer survival is poor, and radiation therapy patients often suffer serious treatment side effects. The esophagus is particularly sensitive leading to acute radiation-induced esophageal damage (ARIED). We investigated the feasibility of optical coherence tomography (OCT) for minimally invasive imaging of the esophagus with high resolution (10 μm) to detect ARIED in mice. Thirty mice underwent cone-beam computed tomography imaging for initial setup assessment and dose planning followed by a single-dose delivery of 4.0, 10.0, 16.0, and 20.0 Gy on 5.0-mm spots, spaced 10.0 mm apart in the esophagus. They were repeatedly imaged using OCT up to three months postirradiation. We compared OCT findings with histopathology obtained three months postirradiation qualitatively and quantitatively using the contrast-to-background-noise ratio (CNR). Histopathology mostly showed inflammatory infiltration and edema at higher doses; OCT findings were in agreement with most of the histopathological reports. We were able to identify the ARIED on OCT as a change in tissue scattering and layer thickness. Our statistical analysis showed significant difference between the CNR values of healthy tissue, edema, and inflammatory infiltration. Overall, the average CNR for inflammatory infiltration and edema damages was 1.6-fold higher and 1.6-fold lower than for the healthy esophageal wall, respectively. Our results showed the potential role of OCT to detect and monitor the ARIED in mice, which may translate to humans. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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“…Toxicities of radiotherapy typically include the organs that are irradiated due to their adjacency to the tumour. These include primarily organs of the thorax, specifically: the spinal cord [61], the lungs [62], the heart [63] and the oesophagus [64]. The typical constraints that are usually aimed for are: volume of organ receiving at least 20 Gy less than 30-35% and a mean lung dose of under 20-23 Gy.…”

Section: Planningmentioning

confidence: 99%

Radio(chemo)therapy in locally advanced nonsmall cell lung cancer

et al. 2016

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Definitive radiochemotherapy is the standard treatment for many patients with locally advanced nonsmall cell lung cancer (NSCLC). Treatment outcomes have improved over the last decades. Several treatment regimens have been shown effective and safe. This review summarises the results of significant studies between 1996 and 2015 on concomitant and sequential radiochemotherapy regimens and radiation dose per fraction. Beside therapy regimens, optimised radiotherapy planning is indispensable to improve outcome and minimise radiation-induced toxicity. An insight into the rationale of radiotherapy planning for stage III NSCLC is also provided. @ERSpublications Concomitant radiochemotherapy is an established standard treatment for locally advanced nonsmall cell lung cancer http://ow.ly/TTkkc

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Predicting Esophagitis After Chemoradiation Therapy for Non-Small Cell Lung Cancer: An Individual Patient Data Meta-Analysis

Cited by 152 publications

References 20 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

Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models

Radio(chemo)therapy in locally advanced nonsmall cell lung cancer

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