Risk factors for esophagitis after hypofractionated palliative (chemo) radiotherapy for non-small cell lung cancer

Nieder, Carsten; Imingen, Kristian S; Mannsåker, Bård; Yobuta, Rosalba; Haukland, Ellinor

doi:10.1186/s13014-020-01550-2

Cited by 5 publications

(9 citation statements)

References 24 publications

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“…Standard supportive measures such as analgesics and parenteral nutrition were initiated to manage esophageal toxicity. We have previously published esophageal dose constraints for palliative (chemo)radiotherapy, based on a smaller study [ 10 ]. As mentioned in that study, our current treatment planning strategy is to limit the maximum dose to the esophagus (Dmax), e.g., by accepting a planning target volume (PTV) coverage of <95% at the intersection with the esophagus.…”

Section: Discussionmentioning

confidence: 99%

“…Intermediate radiation doses between 30 and 60 Gy, such as the Norwegian CONRAD regime (42 Gy in 15 fractions), are also endorsed in current guidelines, preferably in combination with platinum-based chemotherapy [ 8 , 9 ]. Both chemotherapy and radiation are highly likely to induce at least mild or moderate side effects [ 10 , 11 ]. Acute and sub-acute thoracic toxicities causing hospitalization or death are of particular concern in a palliative treatment setting, where the expected outcome is symptom improvement and/or prolongation of survival.…”

Section: Introductionmentioning

confidence: 99%

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Early High-Grade Thoracic Toxicity After Palliative Radiotherapy for Non-Small Cell Lung Cancer

Nieder¹,

Imingen²

2021

Cureus

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Introduction: Palliative radiotherapy or chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) may cause thoracic toxicities due to the radiation dose delivered to the lungs, heart, and esophagus. We studied severe thoracic toxicities resulting in hospitalization or death during the acute and sub-acute phase, i.e., three months from commencing radiotherapy. In addition, risk factors were identified. Methods: A retrospective review of 165 patients treated with three-dimensional conformal palliative radiotherapy or CRT was performed. The prescribed total dose was equivalent to at least 30 Gy in 10 fractions. Uni- and multivariate analyses were employed. Results: Twelve patients (7%) were hospitalized within three months from the start of radiotherapy or CRT. Six patients were hospitalized for esophagitis, three for dyspnea most likely caused by pneumonitis, and three for cardiac arrhythmia. Fatal toxicity was not observed. However, 19% of the 165 patients died from tumor-related causes during the time period of interest. In multivariate analysis, the only esophageal dose was significantly associated with the risk of hospitalization. Conclusion: The safety profile of palliative radiotherapy or CRT in the acute and subacute phases was satisfactory. The hospitalization rate can be reduced by lowering the esophageal dose, as long as safe lung and heart doses can be maintained.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early High-Grade Thoracic Toxicity After Palliative Radiotherapy for Non-Small Cell Lung Cancer

Nieder¹,

Imingen²

2021

Cureus

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“…[ 12 ] found that the volume with the minimum dose of 60 Gy (V 60 ) of the esophagus was a key dosimetric factor to predict ARE. Several dose−volume histogram (DVH) dosimetric parameters of the maximum dose, average dose, the dose with a volume of 5 cc (D 5 cc ) and the volume received dose larger than 20 Gy, 30 Gy, 35 Gy, and 40 Gy (that are V 20, 30, 35, 40 ) of the esophagus [ 13 ] were recognized as predictors of ARE. Other studies also provided discrepant predictors from the esophagus DVH dosimetric parameters, such as V 50 , the equivalent doses, and D 2 cc [ 14 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…One explanation for these discrepancies involves the different DVH factors believed to be associated with ARE, for example, D 5 cc, 10 cc used by Nieder et al . [ 13 ], and equivalent doses (EUD) adopted by Butof et al . [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Multi-omics to predict acute radiation esophagitis in patients with lung cancer treated with intensity-modulated radiation therapy

et al. 2023

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Purpose The study aimed to predict acute radiation esophagitis (ARE) with grade ≥ 2 for patients with locally advanced lung cancer (LALC) treated with intensity-modulated radiation therapy (IMRT) using multi-omics features, including radiomics and dosiomics. Methods 161 patients with stage IIIA−IIIB LALC who received chemoradiotherapy (CRT) or radiotherapy by IMRT with a prescribed dose from 45 to 70 Gy from 2015 to 2019 were enrolled retrospectively. All the toxicity gradings were given following the Common Terminology Criteria for Adverse Events V4.0. Multi-omics features, including radiomics, dosiomics (including dose−volume histogram dosimetric parameters), were extracted based on the planning CT image and three-dimensional dose distribution. All data were randomly divided into training cohorts (N = 107) and testing cohorts (N = 54). In the training cohorts, features with reliably high outcome relevance and low redundancy were selected under random patient subsampling. Four classification models (using clinical factors (CF) only, using radiomics features (RFs) only, dosiomics features (DFs) only, and the hybrid features (HFs) containing clinical factors, radiomics and dosiomics) were constructed employing the Ridge classifier using two-thirds of randomly selected patients as the training cohort. The remaining patient was treated as the testing cohort. A series of models were built with 30 times training–testing splits. Their performances were assessed using the area under the ROC curve (AUC) and accuracy. Results Among all patients, 51 developed ARE grade ≥ 2, with an incidence of 31.7%. Next, 8990 radiomics and 213 dosiomics features were extracted, and 3, 6, 12, and 13 features remained after feature selection in the CF, DF, RF and DF models, respectively. The RF and HF models achieved similar classification performance, with the training and testing AUCs of 0.796 ± 0.023 (95% confidence interval (CI [0.79, 0.80])/0.744 ± 0.044 (95% CI [0.73, 0.76]) and 0.801 ± 0.022 (95% CI [0.79, 0.81]) (p = 0.74), respectively. The model performances using CF and DF features were poorer, with training and testing AUCs of 0.573 ± 0.026 (95% CI [0.56, 0.58])/ 0.509 ± 0.072 (95% CI [0.48, 0.53]) and 0.679 ± 0.027 (95% CI [0.67, 0.69])/0.604 ± 0.041 (95% CI [0.53, 0.63]) compared with the above two models (p < 0.001), respectively. Conclusions In LALC patients treated with CRT IMRT, the ARE grade ≥ 2 can be predicted using the pretreatment radiotherapy image features. To predict ARE, the multi-omics features had similar predictability with radiomics features; however, the dosiomics features and clinical factors had a limited classification performance.

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“…3) Who is at increased risk of unplanned hospitalization? These questions were addressed in a single center retrospective study that utilized an updated, previously established database [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Palliative Thoracic Radiotherapy for Non-Small Cell Lung Cancer in Outpatients: Reasons for Unplanned Hospitalization and Its Impact on Survival

2021

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Background: The aims of the study were to examine the rates of and reasons for unplanned hospitalization after start of palliative radiotherapy or chemoradiation (CRT), and to study whether unplanned hospitalization deteriorates patients' prognosis. In addition, risk factors were identified. Methods: A retrospective review of 136 patients treated with palliative radiotherapy or CRT was performed. Inclusion criteria were prescribed total dose at least 30 Gy and outpatient at the start of treatment. Uni-and multivariate analyses were employed. Results: Fifty-eight patients (43%) were hospitalized within 3 months from start of radiotherapy or CRT. Their median overall survival was 6.7 months as compared to 11.1 months in non-hospitalized patients (P = 0.09). The median length of hospitalization was 8 days (range 1-61). In patients with possibly treatment-related hospitalization (n = 32), median survival was 5.0 months, significantly shorter than the 11.1 months observed in the remaining patients (P = 0.006). In multivariate analysis, only one variable was significantly associated with higher risk of unplanned hospitalization: previous hospitalization in the last 4 weeks before commencing radiotherapy or CRT. Conclusions: Unplanned hospitalization occurred frequently in a standard care setting without early involvement of a dedicated palliative team. Patients with preceding hospitalization might represent a group that is particularly vulnerable, thus qualifying for a targeted intervention aiming at continued outpatient care.

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Risk factors for esophagitis after hypofractionated palliative (chemo) radiotherapy for non-small cell lung cancer

Cited by 5 publications

References 24 publications

Early High-Grade Thoracic Toxicity After Palliative Radiotherapy for Non-Small Cell Lung Cancer

Early High-Grade Thoracic Toxicity After Palliative Radiotherapy for Non-Small Cell Lung Cancer

Multi-omics to predict acute radiation esophagitis in patients with lung cancer treated with intensity-modulated radiation therapy

Palliative Thoracic Radiotherapy for Non-Small Cell Lung Cancer in Outpatients: Reasons for Unplanned Hospitalization and Its Impact on Survival

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