Efficacy of linezolid on gram-positive bacterial infection in elderly patients and the risk factors associated with thrombocytopenia

Objective : Linezolid is active against drug-resistant gram-positive bacteria. However, the efficacy and safety of linezolid in the treatment of the elderly have not been well characterized. The purpose of this study was to evaluate the efficacy of linezolid in the treatment of the elderly with gram-positive bacterial infection and to investigate the risk factors associated with the development of thrombocytopenia in these patients.

METHODOLOGY

This was a retrospective analysis of 50 elderly patients who were treated with intravenous linezolid for gram-positive bacterial infection. Clinical data and bacteriological responses were assessed. Risk factors associated with thrombocytopenia in elderly patients were analyzed.

RESULTS

The overall clinical cure rate of linezolid was 74%, and the bacteriological eradication rate was 69%. Thrombocytopenia occurred in 24 patients, and thrombocytopenia was associated with both the duration of treatment (P = 0.005) and the baseline platelet count (P = 0.042). Based on a logistic regression analysis, the baseline platelet count <200×10(9)/L (OR = 0.244; 95% CI = 0.068- 0.874; P = 0.030) was identified as the only significant risk factor for linezolid-associated thrombocytopenia in elderly patients. The mean platelet count decreased significantly from the 7(th) day of treatment, and decreased to the lowest value 1-2 days after the end of therapy. Conclusions : Linezolid is effective and safe for the elderly with gram-positive bacterial infections. Adverse effects such as thrombocytopenia are of greater concern. Platelet counts should be monitored in patients who are treated with linezolid and that measures should be taken in advance to avoid hemorrhagic tendencies.

Quadratic scaling of intrinsic Gilbert damping with spin-orbital coupling in L10 FePdPt films: experiments and Ab initio calculations

The dependence of the intrinsic Gilbert damping parameter α(0) on the spin-orbital coupling strength ξ is investigated in L1(0) ordered FePd(1-x) Pt(x) films by time-resolved magneto-optical Kerr effect measurements and spin-dependent ab initio calculations. Continuous tuning of α(0) over more than one order of magnitude is realized by changing the Pt/Pd concentration ratio showing that α(0) is proportional to ξ(2) as changes of other leading parameters are found to be negligible. The perpendicular magnetic anisotropy is shown to have a similar variation trend with x. The present results may facilitate the design and fabrication of new magnetic alloys with large perpendicular magnetic anisotropy and tailored damping properties.

Chemical composition tuning of the anomalous Hall effect in isoelectronic L10FePd(1-x)Pt(x) alloy films

The anomalous Hall effect (AHE) in L1(0)FePd(1-x)Pt(x) alloy films is studied both experimentally and theoretically. We find that the intrinsic contribution (σ(AH)(int)) to the AHE can be significantly increased, whereas the extrinsic side-jump contribution (σ(AH)(sj)) can be continuously reduced from being slightly larger than σ(AH)(int) in L1(0) FePd to being much smaller than σ(AH)(int) in L1(0) FePt, by increasing the Pt composition x. We show that this chemical composition tuning of the intrinsic contribution is afforded by the stronger spin-orbit coupling strength on the Pd/Pt site when the lighter Pd atoms are replaced by the heavier Pt atoms. Our results provide a means of manipulating the competing AHE mechanisms in ferromagnetic alloys for fully understanding the AHE and also for technological applications of ferromagnetic alloys.

Rapid identification of Streptococcus iniae by specific PCR assay utilizing genetic markers in ITS rDNA

The 16S-23S intergenic spacers (ITS) of ribosomal DNA from ten independent isolates of Streptococcus iniae and one reference strain ATCC29178 were sequenced, aligned and used to design a polymerase chain reaction (PCR) primer set for rapid and specific detection and identification of S. iniae. This primer set amplified a 377-bp DNA fragment specifically from S. iniae, but not from other common bacterial pathogens of fish or from non-fish pathogens. The PCR conditions were optimized to allow detection of the organism from agar, broth culture or infected fish tissue. The sensitivity of the PCR assay was established by the detection of DNA as low as 0.02 ng or as few as 10 CFU bacterial cells. The establishment of the specific PCR assay provides a useful tool for the identification and diagnosis of fish infection with S. iniae.

Femtosecond laser-drilling-induced HgCdTe photodiodes

Femtosecond-laser drilling may induce holes in HgCdTe with morphology similar to that induced by ion-milling in loophole technique. So-formed hole structures are proven to be pn junction diodes by the laser beam induced current characterization as well as the conductivity measurement. Transmission and photoluminescence spectral measurements on a n-type dominated hole-array structure give rise to different results from those of an ion-milled sample.

Relationship between human papillomavirus 16 and esophageal squamous cell carcinoma in Uygur population in Xinjiang Uygur Autonomous Region

AIM: To investigate the infection rate of human papillomavirus 16 (HPV16) in Uygur patients with esophageal squamous cell carcinoma in Xinjiang.

METHODS: Eighty-two paraffin-embedded specimens of esophageal carcinoma and 80 tumor-adjacent specimens were used in the study. The presence of HPV16 in these specimens was detected by high-sensitivity polymerase chain reaction (PCR) using the type-specific E6 primers.

RESULTS: The infection rates of HPV16 in esophageal squamous cell carcinoma and tumor-adjacent tissue were 31.7% (26/82) and 12.5% (10/80), respectively, showing significant difference between the two groups. HPV16 infection was not correlated with patient's age and sex as well as pathological differentiation and clinical stage of the carcinoma (χ² = 0.301, 0.149, 2.876 and 0.105, respectively; all P > 0.05).

CONCLUSION: HPV 16 infection is possibly correlated with esophageal squamous cell carcinoma in Uygur population in Xinjiang but showed no correlation with patient's age and sex as well as pathological differentiation and clinical stage of the carcinoma.

Electron spin resonance study of polycrystalline La(0.75)(Ca(x)Sr(1-x))(0.25)MnO(3) (x = 0, 0.45, 1)

Electron spin resonance (ESR) spectra of polycrystalline La(0.75)(Ca(x)Sr(1-x))(0.25)MnO(3) (x = 0, 0.45, 1) were studied within the temperature range 110 K≤T≤470 K. The temperature dependence of the ESR intensity for the samples is described by a thermally activated model in the paramagnetic regime. It is found that the activation energy in the orthorhombic phase is higher than that in the rhombohedral phase for La(0.75)(Ca(0.45)Sr(0.55))(0.25)MnO(3). It is suggested that a higher energy is required to destroy the correlated polarons due to the fact that correlated polarons only exist in the orthorhombic phase. This proposition is confirmed by the analysis of the ESR linewidth data, which can be well fitted by the model of adiabatic hopping motion of small polarons. In addition, it is found that, at a fixed temperature, the linewidth decreases with increasing Sr doping, which reveals that the structural tolerance factor has a significant effect on the linewidth.

Lymphocytic HLA-A mRNA is a reliable indicator of acute rejection in renal transplantation

BACKGROUND

Rejection in renal transplantation is the most frequent event causing transplant failure. It is important to identify parameters to predict rejection, which are helpful in a timely fashion.

METHODS

Fifty-nine renal transplant recipients were divided into two groups: group 1 (stable renal function) and group 2 (acute rejection episodes). The levels of HLA-A mRNA in peripheral blood lymphocytes (both pre- and posttransplantation) were measured by reverse transcriptase-polymerase chain reaction (RT-PCR) with glucose-6-phosphate dehydrogenase (G6PDH) as an internal reference. The TEST software was used to analyze the relative expressions of HLA-A mRNA.

RESULTS

There was no statistical significance between features of the two groups pretransplant versus normal controls. Posttransplant, the HLA-A mRNA levels decreased significantly compared to those of pretransplant and normal control individuals. The levels of HLA-A mRNA among the 10 patients with acute rejection episodes were significantly increased. There was no significant change in the lymphocyte populations in the early stage of an acute rejection episode compared with the prerejection value.

CONCLUSION

HLA-A mRNA expression was strongly correlated with immune status. The HLA-A mRNA levels may provide an effective and reliable indicator to predict acute rejection episodes in renal transplantation.

Inhibition of COX-2 and activation of peroxisome proliferator-activated receptor gamma synergistically inhibits proliferation and induces apoptosis of human pancreatic carcinoma cells

Although inhibition of cyclooxygenase-2 (COX-2) or activation of peroxisome proliferators-activated receptor gamma (PPAR-gamma) leads to growth inhibition in malignancies, the synergistic anti-tumor effects of combination of COX-2 inhibitor (NS-398) and PPAR-gamma agonist (rosiglitazone) on the human pancreatic cancer cells remains unknown. Here, we evaluated the effects of NS-398 and/or rosiglitazone on the cell proliferation and apoptosis in a pancreatic cancer cell line, SW1990. NS-398 and rosiglitazone decreased cell proliferation in a dose- and time-dependent manner. Proliferating cell nuclear antigen (PCNA) labeling index significantly decreased in the cells treated with either NS-398 or rosiglitazone. Both NS-398 and rosiglitazone alone induced apoptotic cell death of SW1990. The combination of NS-398 and rosiglitazone exerted synergistic effects on proliferation inhibition, and apoptosis induction in SW1990 cells, with down-regulation of Bcl-2 and up-regulation of Bax expression. Our results indicate that simultaneous targeting of COX-2 and PPAR-gamma inhibits pancreatic cancer development more effectively than targeting each molecule alone.

Rotation of the pinning direction in the exchange bias training effect in polycrystalline NiFe/FeMn bilayers

For polycrystalline NiFe/FeMn bilayers, we have observed and quantified the rotation of the pinning direction in the exchange bias training and recovery effects. During consecutive hysteresis loops, the rotation of the pinning direction strongly depends on the magnetization reversal mechanism of the ferromagnet layer. The interfacial uncompensated magnetic moment of antiferromagnetic grains may be irreversibly switched and rotated when the magnetization reversal process of the ferromagnet layer is accompanied by domain wall motion and domain rotation, respectively.

Blockade of cholecystokinin-2 receptor and cyclooxygenase-2 synergistically induces cell apoptosis, and inhibits the proliferation of human gastric cancer cells in vitro

Gastrin and cyclooxygenase-2 (COX-2) play important roles in the carcinogenesis and progression of gastric cancer. However, it remains unknown whether the combination of cholecystokinin-2 (CCK-2) receptor antagonist plus COX-2 inhibitor exerts synergistic anti-tumor effects on human gastric cancer. Here, we demonstrated that the combination of AG-041R (a CCK-2 receptor antagonist) plus NS-398 (a selective COX-2 inhibitor) treatment had synergistic effects on proliferation inhibition, apoptosis induction, down-regulation of Bcl-2 and up-regulation of Bax expression in MKN-45 cells. These results indicate that simultaneous targeting of CCK-2 receptor and COX-2 may inhibit gastric cancer development more effectively than targeting either molecule alone.

Systemic lupus erythematosus: a genetic epidemiology study of 695 patients from China

Our purpose was to explore potential genetic models for systemic lupus erythematosus (SLE) and analyze genetic epidemiologic characteristics of SLE in a Chinese population. Data for 695 patients with SLE were obtained by using a uniform questionnaire. Patients, clinical characteristics and their family history were analyzed using software. A complex segregation analysis was conducted to propose potential genetic models for SLE. The mean +/- SD age of onset were 30.2 +/- 10.5 years and mean time to progression to SLE was 32.5 +/- 44.4 months. The most frequent initial manifestations were malar rash (61.3%). During the evolution of the disease, the main clinical features were arthritis in 73.6% of our patients, followed by malar rash (68.1%), and renal involvement (56.7%). As the first symptom, the late-onset group (onset of disease beyond the age of 50 years) less often showed malar rash (45% vs. 63.4% in the early-onset group; p = 0.001). There were no significant differences in the other cumulative clinical symptoms between late-onset and early-onset group, except for a lower prevalence of malar rash, photosensitivity and alopecia and a higher prevalence of mucosal ulcers in the late-onset group. A positive family history of SLE was obtained in 50 patients (7.2%). There were no statistical differences in clinical characteristics between familial SLE and sporadic SLE patients. The heritability of SLE was 43.6%, the genetic model of SLE could be polygenetic model and major gene mode is the best fitted one. SLE could be a multifactorial disease with polygenetic model.

Hysteretic behavior of angular dependence of exchange bias in FeNi/FeMn bilayers

For FeNi/FeMn bilayers, the angular dependence of exchange bias shows hysteresis between clockwise and counterclockwise rotations, as a new signature. The hysteresis decreases for thick antiferromagnet layers. Calculations have clearly shown that the orientation of antiferromagnet spins also exhibits hysteresis between clockwise and counterclockwise rotations. This furnishes an interpretation of the macroscopic behavior of the ferromagnetic layer in terms of the thermally driven evolution of the magnetic state of the antiferromagnet layer.

The impact of pre-radiotherapy surgery on radiation-induced lung injury

AIMS

The use of postoperative radiation therapy (PORT) is predicated by an assessment of the potential benefits and risks, including radiation-induced lung injury. In this study, the risk of radiation-induced lung injury is assessed in patients who received PORT, and compared with a group of patients who received radiation without prior surgery, to determine if surgery increases the risk of radiation pneumonitis.

MATERIALS AND METHODS

From 1991 to 2003, 251 patients with lung cancer were enrolled into a prospective study to assess radiation-induced lung injury. All patients received three-dimensional-planned, external-beam radiotherapy. One hundred and seventy-seven patients with over 6-months follow-up were eligible. For the current analysis, 49 patients (28%) had surgical intervention before radiotherapy. The rates of Grade 2 symptomatic pneumonitis in subgroups, based on the type of pre-radiation surgery, were computed and compared using Fisher's Exact Test. To consider the confounding factor of irradiated lung volume, patient subgroups were further defined on the basis of the mean lung dose.

RESULTS

Surgical procedures included pneumonectomy (n=9), lobectomy (n=16), wedge resection (n=8) and exploration without resection (n=16). Radiation-induced lung injury occurred in 33 out of 177 (19%) patients, including 18% of the surgical group and 19% of the non-surgical group. Additionally, no statistically significant difference was found in the rate of radiation-induced lung injury based on the extent of resection.

CONCLUSIONS

The incidence of pneumonitis is similar in the surgical and non-surgical groups. Thus, PORT may be safely given to selected patients after surgical exploration or resection.

Analysis of the drude model in metallic films

A method, believed to be new, to simulate Drude parameters for collective oscillation of the free carriers in metallic films is proposed. Plasma resonance frequency and relaxation were simulated simultaneously from both the real and the imaginary parts of the dielectric function of a metallic film after consideration of their correlation in the Drude model. As examples, the contributions of the electrons in Ag films and of the free carriers in metallic silicide, NbSi(2) and TaSi(2), films have been studied.

Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer

PURPOSE

To relate lung dose-volume histogram-based factors to symptomatic radiation pneumonitis (RP) in patients with lung cancer undergoing 3-dimensional (3D) radiotherapy planning.

METHODS AND MATERIALS

Between 1991 and 1999, 318 patients with lung cancer received external beam radiotherapy (RT) with 3D planning tools at Duke University Medical Center. One hundred seventeen patients were not evaluated for RP because of <6 months of follow-up, development of progressive intrathoracic disease making scoring of pulmonary symptoms difficult, or unretrievable 3D dosimetry data. Thus, 201 patients were analyzed for RP. Univariate and multivariate analyses were performed to test the association between RP and dosimetric factors (i.e., mean lung dose, volume of lung receiving >or=30 Gy, and normal tissue complication probability derived from the Lyman and Kutcher models) and clinical factors, including tobacco use, age, sex, chemotherapy exposure, tumor site, pre-RT forced expiratory volume in 1 s, weight loss, and performance status.

RESULTS

Thirty-nine patients (19%) developed RP. In the univariate analysis, all dosimetric factors (i.e., mean lung dose, volume of lung receiving >or=30 Gy, and normal tissue complication probability) were associated with RP (p range 0.006-0.003). Of the clinical factors, ongoing tobacco use at the time of referral for RT was associated with fewer cases of RP (p = 0.05). These factors were also independently associated with RP according to the multivariate analysis (p = 0.001). Models predictive for RP based on dosimetric factors only, or on a combination with the influence of tobacco use, had a concordance of 64% and 68%, respectively.

CONCLUSIONS

Dosimetric factors were the best predictors of symptomatic RP after external beam RT for lung cancer. Multivariate models that also include clinical variables were slightly more predictive.

Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method

PURPOSE

To examine the acute urinary toxicity following transperineal prostate implant using a modified Quimby loading method with regard to time course, severity, and factors that may be associated with a higher incidence of morbidity.

METHODS AND MATERIALS

One hundred thirty-nine patients with prostate adenocarcinoma treated with brachytherapy from 1997 through 1999 had follow-up records available for review. Patients considered for definitive brachytherapy alone included those with prostate specific antigen (PSA) < or = 6, Gleason score (GS) < or = 6, clinical stage < T2b, and prostate volumes generally less than 40 cc. Patients with larger prostate volumes were given neoadjuvant antiandrogen therapy. Those with GS > 6, PSA > 6, or Stage > T2a were treated with external beam radiation therapy followed by brachytherapy boost. Sources were loaded according to a modified Quimby method. At each follow-up, toxicity was graded based on a modified RTOG urinary toxicity scale.

RESULTS

Acute urinary toxicity occurred in 88%. Grade I toxicity was reported in 23%, grade II in 45%, and grade III in 20%, with 14% requiring prolonged (greater than 1 week) intermittent or indwelling catheterization. Overall median duration of symptoms was 12 months. There was no difference in duration of symptoms between patients treated with I-125 or Pd-103 sources (p = 0.71). After adjusting for GS and PSA, multivariate logistic regression analysis showed higher incidence of grade 3 toxicity in patients with larger prostate volumes (p = 0.002), and those with more seeds implanted (p < 0.001). Higher incidence of prolonged catheterization was found in patients receiving brachytherapy alone (p = 0.01), with larger prostate volumes (p = 0.01), and those with more seeds implanted (p < 0.001).

CONCLUSION

Interstitial brachytherapy for prostate cancer leads to a high incidence of acute urinary toxicity, most of which is mild to moderate in severity. A prolonged need for catheterization can occur in some patients. Patients receiving brachytherapy alone, those with prostate volumes greater than 30 cc, and those implanted with a greater number of seeds have the highest incidence of significant toxicity.

[The enlarged translabyrinthine removal of large acoustic neuromas: 18 cases report]

OBJECTIVE

To investigate the surgical methods and results of enlarged translabyrinthine approach in the removal of large acoustic neuromas.

METHOD

A large mastoidectomy involved complete exposure of sigmoid sinus, the dura behind the sinus for at least 1 cm, the superior petrosal sinus and the middle fossa dura. The jugular bulb was exposed and pressed downwards if necessary. The internal auditory meatus was skeletonized and uncovered for at least 270 degrees. The debulking of the tumor began inside the anterior and inferior poles in order to find the brainstem and the facial nerve root as early as possible, then the dissection of the nerve was performed medially to laterally. Intraoperative facial nerve monitoring and postoperative CT and MRI were performed in all cases.

RESULT

Total removal was achieved in all 18 patients with tumors larger than 3 cm (mean size: 4.2 cm). There were no death as well as other complications such as intracranial infection and persistent cerebrospinal fluid leakage. There were no obvious cerebral sequela. The facial nerve was preserved both anatomically and functionally in 14 cases, with Grade I or II in 8 cases, Grade III or IV in 6 cases. Nerve interruption occurred in 4 cases who all had severe facial paralysis or nerve interruption before operation. 16 patients returned to work within 1-3 months.

CONCLUSION

Total removal of large acoustic neuroma could be accomplished via the translabyrinthine approach, with good result of facial nerve function and minimum incidence of morbidity.

A new three-dimensional dose distribution reduction scheme for tubular organs

In tubular structures, spatial aspects of the dose distribution may be important in determining the normal tissue response. Conventional dose-volume-histograms (DVHs) and dose-surface-histograms (DSHs) lack spatial information and may not be adequate to represent the three-dimensional (3D) dose data. A new 3D dose distribution data reduction scheme which preserves its longitudinal and circumferential character is presented. Dose distributions were generated at each axial level for esophagus or rectum in 123 patients with lung cancer or prostate cancer. Dose distribution histograms at each axial level were independently analyzed along the esophageal or rectal circumference to generate dose-circumference-histogram (DCH) sheets. Two types of plots were then generated from the DCH sheet. The first considered the percentage of the circumference at each axial level receiving various doses. The second considered the minimum dose delivered to any percentage of the circumference at each axial level. The DCH as a treatment planning tool can be easily implemented in a 3D planing system and is potentially useful for the study of the relationship between the complication risk and the longitudinal and circumferential dose distributions.

Routine 3D treatment planning: opportunities, challenges, and hazards

Three-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to the reduction of treatment-associated morbidity and facilitate safe dose escalation for many tumor sites. This technology affords the incorporation of physiologic and anatomic information into the treatment planning process, further enhancing our ability to improve the therapeutic ratio. However, as with any new technology, care must be taken when applying it in the clinic. The introduction of 3D planning presents new challenges to existing quality assurance systems. These need to be addressed to maintain patient safety. Based on our experience with over 1,500 patients treated at Duke University, the benefits, challenges, and hazards of routine 3D treatment planning are discussed.

[The semiconductor diode laser application in tympanoplasty]

OBJECTIVE

To investigate the method, indications and initial results of semiconductor diode laser application in tympanoplasty.

METHOD

The diode laser was used in 14 tympanoplasty procedures. The laser manipulation was mainly used in cases of malleus and incus bony fixation with the tympanum, the fibrous scar tissue around the ossicular chain and the malleus head resection.

RESULT

There was no postoperative vertigo and facial paralysis. The average hearing improvement was 24 dB. Seven cases (50%) reached an air-bone gap within 20 dB.

CONCLUSION

The application of diode laser in tympanoplasty could effectively reduce the manipulation trauma of ossicular chain and control the bleeding of operative field, especially in managing the bony adhesion of the ossicular chain.

Asymmetry in elementary events of magnetization reversal in a ferromagnetic/antiferromagnetic bilayer

Real-time magneto-optical indicator film images reveal distinct asymmetry in the motion of a single domain wall in a wedged-NiFe/uniform-FeMn bilayer due to the nucleation and behavior of an exchange spring in the antiferromagnetic layer. Magnetization reversal from the ground state begins at the thick end of the wedge where the exchange anisotropy field (HE) is minimal and the magnetostatic field (HMS) is maximal, whereas reversal into the ground state begins from the thin end where HE is maximal and HMS is minimal.

Clinical and dosimetric predictors of radiation-induced esophageal toxicity

PURPOSE

To evaluate the incidence, severity, and clinical/dosimetric predictors of acute and chronic esophageal toxicities in patients with non-small cell lung cancer (NSCLC) treated with high-dose conformal thoracic radiation.

METHODS AND MATERIALS

Ninety-one patients with localized NSCLC treated definitively with high-dose conformal radiation therapy (RT) at Duke University Medical Center (DUMC) were reviewed. Patient characteristics were as follows: 53 males and 38 females; median age 64 yr (range 46-82); stage I--16, II--3, IIIa--40, IIIb--30, X--2; dysphagia pre-RT--6 (7%). Treatment parameters included: median corrected dose-78.8 Gy (range 64.2-85.6); BID fractionation-58 (64%); chemotherapy-43 (47%). Acute and late esophageal toxicities were graded by RTOG criteria. Using 3D treatment planning tools, the esophagus was contoured in a uniform fashion, the 3D dose distribution calculated (with lung density correction), and the dose-volume (DVH) and dose-surface histograms (DSH) generated. At each axial level, the percentage of the esophageal circumference at each dose level was calculated. The length of circumferential esophagus and the maximum circumference treated to doses >50 Gy were assessed. Patient and treatment factors were correlated with acute and chronic esophageal dysfunction using univariate and multivariate logistic regression analyses.

RESULTS

There were no acute or late grade 4 or 5 esophageal toxicities. Ten of 91 patients (11%) developed grade 3 acute toxicity. On univariate analysis of clinical parameters, both dysphagia pre-RT (p = 0.10) and BID fractionation (p = 0.11) tended toward significantly predicting grade 3 acute esophagitis. None of the dosimetric parameters analyzed significantly predicted for grade 3 acute esophagitis. Twelve of 66 assessable patients (18%) developed late esophageal toxicity. Of the clinical parameters analyzed, only dysphagia pre-RT (p = 0.06) tended toward significantly predicting late esophageal toxicity. On univariate analyses, the effects of percent organ volume treated >50 Gy (p = 0.05), percent surface area treated >50 Gy (p = 0.05), length of 100% circumference treated >50 Gy (p = 0.04), and maximum percent of circumference treated >80 Gy (p = 0.01) significantly predicted for late toxicity of all grades. On multivariate analysis, percent organ volume treated >50 Gy (p = 0.02) and maximum percent of circumference treated >80 Gy (p = 0.02) predicted for late toxicity.

CONCLUSIONS

Late esophageal toxicity following aggressive, high-dose conformal radiotherapy is common but rarely severe. Dosimetric variables addressing the longitudinal and circumferential character of the esophagus have biologic rationale and are predictive of late toxicity. Further studies are needed to assess whether these parameters are better predictors than those derived from traditional DVHs.