Abstract
The purpose of this study was to determine the clinical and dosimetric factors associated with acute esophagitis (AE) in lung cancer patients treated with conformal radiotherapy (RT) in Turkey. In this retrospective review 104 lung cancer patients were examined. Esophagitis grades were verified weekly during treatment, and at 1 week, and 1 and 2 months afterwards. The clinical parameters included patient age, gender, tumor pathology, number of chemotherapy treatments before RT, concurrent chemotherapy, radiation dose, tumor response to RT, tumor localization, interruption of RT, weight loss, tumor and nodal stage and tumor volume. The following dosimetric parameters were analyzed for correlation of AE: The maximum (Dmax) and mean (Dmean) doses delivered to the esophagus, the percentage of esophagus volume receiving ≥10 Gy (V10), ≥20 Gy (V20), ≥30 Gy (V30), ≥35 Gy (V35), ≥40 Gy (V40), ≥45 Gy (V45), ≥50 Gy (V50) and ≥60 Gy (V60). Fifty-five patients (52.9%) developed AE. Maximum grades of AE were recorded: Grade 1 in 51 patients (49%), and Grade 2 in 4 patients (3.8%). Clinical factors had no statistically significant influence on the incidence of AE. In terms of dosimetric findings, correlation analyses demonstrated a significant association between AE and Dmax (>5117 cGy), Dmean (>1487 cGy) and V10-60 (percentage of volume receiving >10 to 60 Gy). The most significant relationship between RT and esophagitis were in Dmax (>5117 cGy) (p=0.002) and percentage of esophageal volume receiving >30 Gy (V30>31%) (p=0.008) in the logistic regression analysis. The maximum dose esophagus greater than 5117 cGy and approximately one third (31%) of the esophageal volume receiving >30 Gy was the most statistically significant predictive factor associated with esophagitis due to RT.
Highlights
Radiotherapy (RT) is used in the treatment of 64% of cases with lung cancer (Tyldesley et al, 2001)
The purpose of this study was to determine the clinical and dosimetric factors associated with acute esophagitis (AE) in lung cancer patients treated with conformal radiotherapy (RT) in Turkey
The following dosimetric parameters were analyzed for correlation of AE: The maximum (Dmax) and mean (Dmean) doses delivered to the esophagus, the percentage of esophagus volume receiving ≥10 Gy (V10), ≥20 Gy (V20), ≥30 Gy (V30), ≥35 Gy (V35), ≥40 Gy (V40), ≥45 Gy (V45), ≥50 Gy (V50) and ≥60 Gy (V60)
Summary
Radiotherapy (RT) is used in the treatment of 64% of cases with lung cancer (with a curative intent in 46%) (Tyldesley et al, 2001). Tumors close to the midline and mediastinal lymphadenopathies increase the dose of exposure of the esophagus. For this reason, acute esophagitis (AE) is a frequent adverse effect seen in patients receiving RT for lung cancer. Administration of CRT, hyperfractioned RT, esophageal volume receiving a dose (%) more than 35 Gy (V35), V45, V50, V60, and mean esophageal dose (Dmean), and environmental and volumetric esophageal doses have been faulted for AE development in the literature (Maguire et al, 1999; Werner Wasik et al, 2000; Bradley et al, 2004; Patel et al, 2004; Rose et al, 2009). The aim of this study is to evaluate the association between the dose distribution, clinical factors, and AE development in the esophagus during the treatment of lung cancer
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