Abstract
BackgroundTo investigate the incidence of radiation esophagitis (RE) and tumor local control using esophagus sparing technique in locally advanced non-small cell lung cancer (LANSCLC) treated by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and concurrent chemotherapy.MethodsEighty-seven patients with stage IIIA/B NSCLC who received definitive SIB-IMRT and concurrent chemotherapy had been divided into two groups: 1.with esophagus sparing technique; 2.without esophagus sparing technique. Chi-square test was performed to compare sex, clinical stage, histology, concurrent chemotherapy, RE and nutrition status between two groups. T-test was used to compare the dosimetric parameters. Overall survival (OS) and loco-regional failure free survival (LRFS) were calculated by the Kaplan–Meier method and compared by a log-rank test.ResultsThere were 44 patients in the esophagus sparing group and 43 in the non-sparing group. The incidence of severe RE (Grade 3) was significantly lower in patients with esophagus sparing technique (p = 0.002). Patients in esophagus sparing group had better nutrition status (p = 0.045). With a median follow-up of 18 months (range 1–51 months), the 1-year, 2-year and 3-year OS of all the patients was 86.6, 65.4 and 43.7%. The 1-year, 2-year LRFS was 78.4, 65.9%. OS time (p = 0.301) and LRFS (p = 0.871) was comparable between two groups.ConclusionsEsophagus-sparing technique is an effective and essential method to limit RE in LANSCLC treated by SIB-IMRT and concurrent chemotherapy without compromising local control.
Highlights
To investigate the incidence of radiation esophagitis (RE) and tumor local control using esophagus sparing technique in locally advanced non-small cell lung cancer (LANSCLC) treated by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and concurrent chemotherapy
Recent studies showed that concurrent chemotherapy and hyperfrationated radiotherapy improved overall survival and local control; higher incidence of severe esophagitis had been observed in patients using these treatment schemes [9,10,11,12,13,14]
Results of RTOG 0617 showed that mean lung dose, lung V20, esophagus dose and heart dose were significantly higher in patients who received high-dose chemoradiotherapy than those in standard-dose group, and treatment-related deaths were more common in the high-dose group
Summary
To investigate the incidence of radiation esophagitis (RE) and tumor local control using esophagus sparing technique in locally advanced non-small cell lung cancer (LANSCLC) treated by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and concurrent chemotherapy. High-dose radiotherapy with concurrent chemotherapy is a radical treatment option in stage III non-small cell lung cancer (NSCLC) patients who are not suitable for surgery. The incidence of severe acute esophagitis (grade 3 or higher) was reported to be about 8.7–20% in NSCLC patients treated with IMRT-based concurrent chemoradiotherapy [3, 4]. Recent studies showed that concurrent chemotherapy and hyperfrationated radiotherapy improved overall survival and local control; higher incidence of severe esophagitis had been observed in patients using these treatment schemes [9,10,11,12,13,14]
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