Clinical, dosimetric, and position factors for radiation-induced acute esophagitis in intensity-modulated (chemo)radiotherapy for locally advanced non-small-cell lung cancer
Received 18 May 2018
Accepted for publication 14 August 2018
Published 21 September 2018 Volume 2018:11 Pages 6167—6175
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr William Cho
Jin Huang,1 Tianyu He,1 Ronghui Yang,2 Tianlong Ji,1 Guang Li1
1Department of Radiotherapy, The First Hospital of China Medical University, Shenyang 110001, China; 2Department of Hematology, Shengjing Hospital of China Medical University, Shenyang 110000, China
Purpose: The purpose of this study was to estimate the relation between acute esophagitis (AE) and clinical, dosimetric, and position factors in patients with locally advanced non-small-cell lung cancer (NSCLC) receiving intensity-modulated (chemo)radiotherapy.
Materials and methods: A retrospective cohort analysis was performed to identify factors associated with Common Toxicity Criteria for Adverse Events grade 2 or worse AE (AE2+). A multivariable model was established including patient- and treatment-related variables and esophageal dose–volume histogram parameters. The esophagus was divided according to physiological anatomy, and logistic regression was used to analyze the position parameter for its correlation with AE2+.
Results: The incidence of AE2+ was 27.5%. All models included gender, concurrent chemoradiotherapy (CCRT), position parameter, and one of the dosimetric variables. The model with mean dose showed the best goodness of fit. Gender (OR=2.47, P=0.014), CCRT (OR=3.67, P=0.015), mean dose (OR=1.33, P<0.001), and maximum radiation position (OR=1.65, P=0.016) were significantly related to AE2+.
Conclusion: Gender, concurrent chemotherapy, maximum radiation position, and mean dose were independent risk factors for AE2+. The upper part of the esophagus showed a higher sensitivity to radiation toxicity.
Keywords: acute esophagitis, non-small-cell lung cancer, intensity-modulated radiation therapy, position parameter
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