Predictors of Acute Radiation Esophagitis in Non-small Cell Lung Cancer Patients Treated With Accelerated Hyperfractionated Chemoradiotherapy

Abstract

Background/Aim: To identify the clinical and dosimetric predictors of severe acute radiation esophagitis (RE) in patients with non-small cell lung cancer (NSCLC) treated with accelerated hyperfractionated concurrent chemoradiotherapy (AH-CCRT) with concomitant boost technique. Patients and Methods: A total of 159 patients who underwent AH-CCRT (64 Gy in 40 fractions twice daily) were retrospectively identified. Severe RE was designated as grade 3 or higher according to the Common Terminology Criteria for Adverse Events, version 4.0. Results: The incidence rate of grade 3 RE was 15.1% (24/159). The multivariate analysis that incorporated the Eastern Cooperative Oncology Group performance status (ECOG PS, ≥1 vs. 0) and the relative esophagus volume irradiated with at least 60 Gy (V 60) was optimal. Patients with a V 60 of ≥15% had a 37.8% risk of grade 3 RE compared to a 6.1% risk among those with a V 60 of <15%. Conclusion: ECOG PS (≥1 vs. 0) and the V 60 were found to be significant risk factors for severe RE in NSCLC patients who underwent AH-CCRT. Non-small cell lung cancer (NSCLC) is a major cause of death worldwide. The standard of care for patients with locally 491 This study was presented in part as poster at the 59th Annual Meeting of the

Machine learning highlights the deficiency of conventional dosimetric constraints for prevention of high-grade radiation esophagitis in non-small cell lung cancer treated with chemoradiation

“…In our dataset, we observed grade 3 radiation esophagitis in 23 of 202 patients (11.4%), which is lower than historically observed rates of >15% [3,10,35,37]. The comparatively low radiation esophagitis rates we report here may reflect treatment improvements over eras reflecting improved symptom prevention and proactive care, as well as advanced radiation treatment modalities.…”

“…It also contrasts with dosimetric factors including eso mean, eso max, as well as eso V20, eso V35, eso V60 which have been analyzed retrospectively in [35], and using a mixture of retrospective and prospective collected datasets in [9]. It is important to note that we specifically examined grade 3 RE, whereas much of the prior literature has examined grade 2 esophagitis, a less clinically impactful toxicity [36,37].…”

“…We further attribute the difference in results between our current models and the prior literature to a combination of the different toxicity endpoint assessed (grade 3 vs. grade 2), variance in radiation techniques, and implementation of resampling. Previously published reports using models developed using a median cohort size of 141 (well below our actual cohort), and median rate of radiation esophagitis of 11.1%, used logistic regression approaches [1,9,12,17,31,32,34,36,37,39], while some other studies would fit Lyman-Kutcher-Burman (LKB) models, both using pre-IMRT era cohorts [14,33], which may not reflect the current risks of radiation-induced toxicity in a contemporary setting. A more recent study used lasso regularization using a smaller cohort of 94 patients, where 16% developed radiation esophagitis [35].…”

A novel nomogram containing acute radiation esophagitis predicting radiation pneumonitis in thoracic cancer receiving radiotherapy

“…There are several possible reasons that may explain the predictive value of SARE to SRP. First of all, SARE can reflect the high esophageal radiation dose [ 27 , 28 ], which further implicates the increase of radiation dose in the surrounding lung tissue. Secondly, the esophagus and lung are radiosensitive organs, and the early occurrence of SARE may further indicates the high radiosensitivity of the body tissue.…”

A Novel Nomogram Containing Acute Radiation Esophagitis Predicting Radiation Pneumonitis in Thoracic Cancer Receiving Radiotherapy

“…There are several possible reasons that may explain the predictive value of SARE to SRP. First of all, SARE can re ect the high esophageal radiation dose [26,27] , which may further implicates the increase of radiation dose in the surrounding lung tissue. Secondly, the esophagus and lung are both radiosensitive organs, and the early occurrence of SARE may further indicate the high radiosensitivity of the body tissue.…”