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

Abstract

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.

Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation

“…Relevant studies related to this study are of West et al 14 and Alexander Yaney et al 15 Both have evaluated the dosimetric parameters associated with radiation-induced oesophagitis in Ca breast patients undergoing regional nodal irradiation (RNI). In both the aforementioned studies, dose prescribed was 50 Gy in 25 fractions.…”

“…13 However, there are only limited studies related to the oesophageal dose and oesophagitis in radiotherapy of Ca Breast. Out of the very limited works that are available, West et al 14 have evaluated the factors influencing acute oesophagitis and Yaney et al 15 have studied the dosimetric parameters associated with acute esophagitis. The aim of this work is to analyse the effect of oesophagus delineation on the dose received by oesophagus while treating Carcinoma Breast with 3DCRT.…”

Prediction factors of radiation esophagitis in breast cancer patients undergoing supraclavicular radiotherapy

“…[ 1 ] However, RT to supraclavicular fossa (SCF) nodal is suspected to result in esophagitis. [ 2 ] The esophagus is near the SCF node, mainly on the left side of the cervical spine and anatomically divided into three parts: cervical, thoracic, and abdominal, and it begins at the lower border of the cricoid cartilage. The general orientation of the esophagus is vertical, but there are two small bends in the esophagus.…”

“…evaluated some factors that associated with the development of acute esophageal toxicity, using conventional fractionation radiotherapy (50 Gy in 25 fractions). [ 2 ]…”

Molecular Profiling for Predictors of Radiosensitivity in Patients with Breast or Head-and-Neck Cancer

“…The conformal RT plan is based on 3D scans of the tumor region. Dosimetry errors, leading to overexposure of the healthy surrounding tissue, can usually be ruled out as the cause of severe side effects in a specific organ [4]. Consequently, it can be assumed that a high risk of developing severe side effects is related to the patient´s intrinsic RS.…”