Factors associated with acute esophagitis during radiation therapy for lung cancer
Recommended Citation
Herr DJ, Yin H, Bergsma D, Dragovic AF, Matuszak M, Grubb M, Dominello M, Movsas B, Kestin LL, Boike T, Bhatt A, Hayman JA, Jolly S, Schipper M, and Paximadis P. Factors associated with acute esophagitis during radiation therapy for lung cancer. Radiother Oncol 2024; 197:110349.
Document Type
Article
Publication Date
8-1-2024
Publication Title
Radiotherapy and oncology
Abstract
INTRODUCTION: Limiting acute esophagitis remains a clinical challenge during the treatment of locally advanced non-small cell lung cancer (NSCLC).
METHODS: Demographic, dosimetric, and acute toxicity data were prospectively collected for patients undergoing definitive radiation therapy +/- chemotherapy for stage II-III NSCLC from 2012 to 2022 across a statewide consortium. Logistic regression models were used to characterize the risk of grade 2 + and 3 + esophagitis as a function of dosimetric and clinical covariates. Multivariate regression models were fitted to predict the 50 % risk of grade 2 esophagitis and 3 % risk of grade 3 esophagitis.
RESULTS: Of 1760 patients, 84.2 % had stage III disease and 85.3 % received concurrent chemotherapy. 79.2 % of patients had an ECOG performance status ≤ 1. Overall rates of acute grade 2 + and 3 + esophagitis were 48.4 % and 2.2 %, respectively. On multivariate analyses, performance status, mean esophageal dose (MED) and minimum dose to the 2 cc of esophagus receiving the highest dose (D2cc) were significantly associated with grade 2 + and 3 + esophagitis. Concurrent chemotherapy was associated with grade 2 + but not grade 3 + esophagitis. For all patients, MED of 29 Gy and D2cc of 61 Gy corresponded to a 3 % risk of acute grade 3 + esophagitis. For patients receiving chemotherapy, MED of 22 Gy and D2cc of 50 Gy corresponded to a 50 % risk of acute grade 2 + esophagitis.
CONCLUSIONS: Performance status, concurrent chemotherapy, MED and D2cc are associated with acute esophagitis during definitive treatment of NSCLC. Models that quantitatively account for these factors can be useful in individualizing radiation plans.
Medical Subject Headings
Humans; Esophagitis; Lung Neoplasms; Male; Female; Carcinoma, Non-Small-Cell Lung; Aged; Middle Aged; Acute Disease; Radiotherapy Dosage; Radiation Injuries; Prospective Studies; Adult; Aged, 80 and over; Risk Factors
PubMed ID
38815695
Volume
197
First Page
110349
Last Page
110349
