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Quashie EE, Li XA, Prior P, Awan M, Schultz C, Tai A. Obtaining organ-specific radiobiological parameters from clinical data for radiation therapy planning of head and neck cancers. Phys Med Biol 2023; 68:245015. [PMID: 37903437 DOI: 10.1088/1361-6560/ad07f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/30/2023] [Indexed: 11/01/2023]
Abstract
Objective.Different radiation therapy (RT) strategies, e.g. conventional fractionation RT (CFRT), hypofractionation RT (HFRT), stereotactic body RT (SBRT), adaptive RT, and re-irradiation are often used to treat head and neck (HN) cancers. Combining and/or comparing these strategies requires calculating biological effective dose (BED). The purpose of this study is to develop a practical process to estimate organ-specific radiobiologic model parameters that may be used for BED calculations in individualized RT planning for HN cancers.Approach.Clinical dose constraint data for CFRT, HFRT and SBRT for 5 organs at risk (OARs) namely spinal cord, brainstem, brachial plexus, optic pathway, and esophagus obtained from literature were analyzed. These clinical data correspond to a particular endpoint. The linear-quadratic (LQ) and linear-quadratic-linear (LQ-L) models were used to fit these clinical data and extract relevant model parameters (alpha/beta ratio, gamma/alpha,dTand BED) from the iso-effective curve. The dose constraints in terms of equivalent physical dose in 2 Gy-fraction (EQD2) were calculated using the obtained parameters.Main results.The LQ-L and LQ models fitted clinical data well from the CFRT to SBRT with the LQ-L representing a better fit for most of the OARs. The alpha/beta values for LQ-L (LQ) were found to be 2.72 (2.11) Gy, 0.55 (0.30) Gy, 2.82 (2.90) Gy, 6.57 (3.86) Gy, 5.38 (4.71) Gy, and the dose constraint EQD2 were 55.91 (54.90) Gy, 57.35 (56.79) Gy, 57.54 (56.35) Gy, 60.13 (59.72) Gy and 65.66 (64.50) Gy for spinal cord, optic pathway, brainstem, brachial plexus, and esophagus, respectively. Additional two LQ-L parametersdTwere 5.24 Gy, 5.09 Gy, 7.00 Gy, 5.23 Gy, and 6.16 Gy, and gamma/alpha were 7.91, 34.02, 8.67, 5.62 and 4.95.Significance.A practical process was developed to extract organ-specific radiobiological model parameters from clinical data. The obtained parameters can be used for biologically based radiation planning such as calculating dose constraints of different fractionation regimens.
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Affiliation(s)
- Edwin E Quashie
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
- Department of Radiation Oncology, Brown University School of Medicine, Providence, RI 02903, United States of America
- Department of Radiation Oncology, Rhode Island Hospital, Providence, RI 02903, United States of America
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Phillip Prior
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Christopher Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
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Abstract
Dose constraints are essential for performing dosimetry, especially for intensity modulation and for radiotherapy under stereotaxic conditions. We present the update of the recommendations of the French society of oncological radiotherapy for the use of these doses in classical current practice but also for reirradiation.
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Affiliation(s)
- G Noël
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - D Antoni
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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Khalifa J, Lerouge D, Le Péchoux C, Pourel N, Darréon J, Mornex F, Giraud P. Radiotherapy for primary lung cancer. Cancer Radiother 2021; 26:231-243. [PMID: 34953709 DOI: 10.1016/j.canrad.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Herein are presented the recommendations from the Société française de radiothérapie oncologique regarding indications and modalities of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.
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Affiliation(s)
- J Khalifa
- Département de radiothérapie, Institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - D Lerouge
- Département de radiothérapie, centre François-Baclesse, 3, avenue du General-Harris, 14076 Caen, France
| | - C Le Péchoux
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - N Pourel
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France
| | - J Darréon
- Service de physique médicale, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - F Mornex
- Service de radiothérapie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France
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Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
There are only limited studies available in literature that discuss methods to reduce the oesophageal dose and acute oesophagitis during breast cancer radiotherapy. The aim of this study is to compare dose volumetric parameters of oesophagus in radiation treatment of breast with and without oesophagus delineation.
Methods:
Treatment plans of 44 patients, who underwent chest wall and supraclavicular fossa irradiation, were selected for the study. Oesophagus was later delineated and treatment replanned using three-dimensional conformal radiotherapy (3DCRT) considering oesophagus as an organ at risk (OAR). The dose prescribed was 40 Gy/15 fractions to the planning target volume (PTV). Dose volumetric parameters of oesophagus such as maximum dose (Dmax), mean dose (Dmean), the percentage of oesophagus volume receiving ≥15Gy (V15), ≥25Gy(V25), ≥33Gy(V33) and ipsilateral lung volume parameters V4, V8 and V16 were compared with already executed plans in which oesophagus was not delineated.
Results:
Contouring the oesophagus as an OAR as a part of the radiotherapy treatment for Carcinoma Breast resulted in statistically significant reduction in dose to the oesophagus. No statistically significant change was found in the ipsilateral lung volume parameters. No compromise in plan quality was required as evident from the statistically non-significant differences in Homogeneity index and Conformity index.
Findings:
3DCRT planning with oesophagus delineation can be considered as a method to reduce oesophageal dose and the acute oesophageal toxicity during radiotherapy for carcinoma breast.
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Bourbonne V, Lucia F, Jaouen V, Bert J, Rehn M, Pradier O, Visvikis D, Schick U. Development and prospective validation of a spatial dose pattern based model predicting acute pulmonary toxicity in patients treated with volumetric arc-therapy for locally advanced lung cancer. Radiother Oncol 2021; 164:43-49. [PMID: 34547351 DOI: 10.1016/j.radonc.2021.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION (Chemo)-radiotherapy is the standard treatment for patients with locally advanced lung cancer (LALC) not accessible to surgery. Despite strict application of dose constraints, acute toxicities such as acute pulmonary toxicity (APT) remain frequent, and may impact treatment's compliance and patients' quality of life. Previously, on a population treated with intensity-modulated photon therapy or passive scattering proton therapy, spatial dose patterns associated with APT were identified in the lower lungs, especially in the posterior right lung. In the present study, we aim to define these spatial dose patterns on a retrospective cohort treated by volumetric-arctherapy (VMAT) and to validate our findings prospectively. METHODS For the training cohort, we retrospectively included all patients treated in our institution by VMAT for a LALC between 2015 and 2018. APT was scored according to the CTCAE v4.0 scale. All dose maps were registered to a thorax phantom using a segmentation-based elastic registration. Voxel-based analysis of local dose differences was performed with a non-parametric permutation test accounting for n = 10.000 permutations, producing a 3-dimensional significance maps on which clusters of voxels that exhibited significant dose differences (p < 0.05) between the two toxicity groups (APT ≥ grade 2 vs APT < grade 2) were identified. A prediction model (Pmap-Model) was then built using a neural network approach and then applied to an observational prospective cohort for validation. The model was evaluated using the Area under the curve (AUC) and the balanced accuracy (Bacc: mean of the sensitivity and specificity). RESULTS 165 and 42 patients were included in the training and validation cohorts, with respective APT rates of 22.4% and 19.1%. In the training cohort, a cluster of voxels (Pmap-region) was identified in the posterior right lung. In the training cohort, the Pmap-Model combining 11 features among which the mean dose to the Pmap-region resulted in an AUC of 0.99 and a Bacc of 99.2 using an 8% probability threshold. Using the same voxel cluster on the validation cohort, the Pmap-model resulted in an AUC of 0.81 and a Bacc of 82.0. CONCLUSION Our APT-prediction model was successfully validated in a prospective cohort treated by VMAT. Regional radiosensitivity should be considered in usual lung dose constraints, opening the possibility of easily implementable adaptive dosimetry planning.
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Affiliation(s)
- Vincent Bourbonne
- Department of Radiation Oncology, University Hospital, Brest, France; LaTIM UMR 1101 INSERM, University Brest, Brest, France.
| | - François Lucia
- Department of Radiation Oncology, University Hospital, Brest, France; LaTIM UMR 1101 INSERM, University Brest, Brest, France
| | - Vincent Jaouen
- LaTIM UMR 1101 INSERM, University Brest, Brest, France; Institut Mines-Télécom Atlantique, Brest, France
| | - Julien Bert
- LaTIM UMR 1101 INSERM, University Brest, Brest, France
| | - Martin Rehn
- Department of Radiation Oncology, University Hospital, Brest, France
| | - Olivier Pradier
- Department of Radiation Oncology, University Hospital, Brest, France; LaTIM UMR 1101 INSERM, University Brest, Brest, France
| | | | - Ulrike Schick
- Department of Radiation Oncology, University Hospital, Brest, France; LaTIM UMR 1101 INSERM, University Brest, Brest, France
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Kaymak ZA, Ozkan EE. The prognostic value of decrease in prognostic nutritional index in stage III non-small cell lung cancer patients during curative thoracic radiotherapy. Indian J Cancer 2021; 0:318895. [PMID: 34380831 DOI: 10.4103/ijc.ijc_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Curative thoracic radiotherapy (CTRT) with concurrent chemotherapy has been considered as standard treatment approach for stage-III non-small cell lung cancer (NSCLC). The hematological and esophageal toxicities that have been encountered during CTRT would affect the immunonutritional status of the patients. The aim of this study is to evaluate the prognostic value of the change in pre- and post-treatment prognostic nutritional index (PNI) in stage-III NSCLC patients. METHODS Eighty seven consecutive stage III NSCLC patients' data were collected. Pre-radiotherapy (RT) and post-RT PNI values were calculated and the impact of prognostic value of PNI change on overall survival (OS) was evaluated by univariate and multivariate Cox regression analyses. A cutoff value of PNI change was obtained by receiver operator characteristic (ROC) curve analysis. RESULTS The cutoff value was found to be a 22% decrease in PNI by ROC curve analysis in terms of effect on OS. The median OS of low and high PNI decrease groups were 22.5 and 16.5 months respectively (P = 0,001). In univariate and multivariate analyses PNI decrease of ≥ 22% was found to be an independent poor prognostic factor for OS (P = 0.012) and hazard ratio (95% confidence interval)= 2.05 (1.16-3.62). CONCLUSION The PNI change would be a convenient parameter to assess the immunonutritional status of the patient at the end of CTRT. A decrease of more than 22% of PNI value may predict poor prognosis.
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Affiliation(s)
- Zumrut Arda Kaymak
- Department of Radiation Oncology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Emine Elif Ozkan
- Department of Radiation Oncology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Imano N, Nishibuchi I, Kawabata E, Kinugasa Y, Shi L, Sakai C, Ishida M, Sakane H, Akita T, Ishida T, Kimura T, Murakami Y, Tanaka K, Horikoshi Y, Sun J, Nagata Y, Tashiro S. Evaluating Individual Radiosensitivity for the Prediction of Acute Toxicities of Chemoradiotherapy in Esophageal Cancer Patients. Radiat Res 2021; 195:244-252. [PMID: 33400798 DOI: 10.1667/rade-20-00234.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
In this work, individual radiosensitivity was evaluated using DNA damage response and chromosomal aberrations (CAs) in peripheral blood lymphocytes (PBLs) for the prediction of acute toxicities of chemoradiotherapy (CRT) in esophageal cancer patients. Eighteen patients with esophageal cancer were enrolled in this prospective study. Prescribed doses were 60 Gy in 11 patients and 50 Gy in seven patients. Patients received 2 Gy radiotherapy five days a week. PBLs were obtained during treatment just before and 15 min after 2 Gy radiation therapy on the days when the cumulative dose reached 2, 20, 40 Gy and 50 or 60 Gy. PBLs were also obtained four weeks and six months after radiotherapy in all and 13 patients, respectively. Dicentric and ring chromosomes in PBLs were counted to evaluate the number of CAs. Gamma-H2AX foci per cell were scored to assess DNA double-strand breaks. We analyzed the association between these factors and adverse events. The number of γ-H2AX foci before radiotherapy showed no significant increase during CRT, while their increment was significantly reduced with the accumulation of radiation dose. The mean number of CAs increased during CRT up to 1.04 per metaphase, and gradually decreased to approximately 60% six months after CRT. Five patients showed grade 3 toxicities during or after CRT (overreactors: OR), while 13 had grade 2 or less toxicities (non-overreactors: NOR). The number of CAs was significantly higher in the OR group than in the NOR group at a cumulative dose of 20 Gy (mean value: 0.63 vs. 0.34, P = 0.02), 40 Gy (mean value: 0.90 vs. 0.52, P = 0.04), and the final day of radiotherapy (mean value: 1.49 vs. 0.84, P = 0.005). These findings suggest that number of CAs could be an index for predicting acute toxicities of CRT for esophageal cancer.
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Affiliation(s)
- Nobuki Imano
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Emi Kawabata
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasuha Kinugasa
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Lin Shi
- Institute of Medical Imaging and Digital Medicine, School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Chiemi Sakai
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mari Ishida
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Sakane
- Department of Diagnostic Radiology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kimio Tanaka
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasunori Horikoshi
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Jiying Sun
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Tashiro
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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8
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Bourbonne V, Delafoy A, Lucia F, Quéré G, Pradier O, Schick U. Toxicity after volumetric modulated arc therapy for lung cancer: a monocentric retrospective study. Transl Lung Cancer Res 2021; 10:156-166. [PMID: 33569301 PMCID: PMC7867762 DOI: 10.21037/tlcr-20-406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Intensity-modulated radiotherapy (RT) is now widely implemented and has replaced classical three-dimensional (3D)-RT in many tumor sites, as it allows a better target dose conformity and a better sparing of organs a risk (OAR), at the expense, however, of increasing the volume of low dose to normal tissues. Clinical data on toxicities using volumetric modulated arc therapy (VMAT) in lung cancer remain scarce. We aimed to report both acute (APT) and late (LPT) pulmonary and acute (AET) and late (LET) oesophageal toxicities in such setting. Methods All patients treated for a primary lung cancer with VMAT +/- chemotherapy (ChT) in our center from 2014 to 2018 were retrospectively included. Usual clinical, treatment and dosimetric features were collected. Univariate analysis was performed using the receiver operative characteristics approach while multivariate analysis (MVA) relied on logistic regression, calculated with Medcalc 14.8.1. Results In total, 167 patients were included, with a median age of 66 years (39-88 years). Median radiation dose was 66 Gy (30-66 Gy); 82% patients received concomitant (32.3%), induction (25.7%) or induction followed by concomitant ChT (24%). After a median follow-up of 14.0 months, the G ≥2 APT, AET, LPT and LET rates were 22.2%, 30.0%, 16.8% and 5.4%, respectively with low grade ≥3 toxicity rates (respectively, 3%, 6.6%, 3% and 0%). On MVA, APT was significantly associated with V30 to the homolateral lung, AET with age, LPT with MEVS while no feature remained significantly correlated with LET. Conclusions Low rates of pulmonary and esophageal toxicity were observed in our cohort. Larger prospective studies are needed to confirm these results.
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Affiliation(s)
- Vincent Bourbonne
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| | - Alice Delafoy
- Radiation Oncology Department, CHRU Brest, Brest, France
| | - François Lucia
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| | - Gilles Quéré
- Medical Oncology Department, CHRU Brest, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
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Bourbonne V, Da-Ano R, Jaouen V, Lucia F, Dissaux G, Bert J, Pradier O, Visvikis D, Hatt M, Schick U. Radiomics analysis of 3D dose distributions to predict toxicity of radiotherapy for lung cancer. Radiother Oncol 2020; 155:144-150. [PMID: 33161012 DOI: 10.1016/j.radonc.2020.10.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE (Chemo)-radiotherapy (RT) is the gold standard treatment for patients with locally advanced lung cancer non accessible for surgery. However, current toxicity prediction models rely on clinical and dose volume histograms (DVHs) and remain unsufficient. The goal of this work is to investigate the added predictive value of the radiomics approach applied to dose maps regarding acute and late toxicities in both the lungs and esophagus. METHODS Acute and late toxicities scored using the CTCAE v4.0 were retrospectively collected on patients treated with RT in our institution. Radiomic features were extracted from 3D dose maps considering Gy values as grey-levels in images. DVH and usual clinical factors were also considered. Three toxicity prediction models (clinical only, clinical + DVH and combined, i.e., including clinical + DVH + radiomics) were incrementally trained using a neural network on 70% of the patients for prediction of grade ≥2 acute and late pulmonary toxicities (APT/LPT) and grade ≥2 acute esophageal toxicities (AET). After bootstrapping (n = 1000), optimal cut-off values were determined based on the Youden Index. The trained models were then evaluated in the remaining 30% of patients using balanced accuracy (BAcc). RESULTS 167 patients were treated from 2015 to 2018: 78% non small-cell lung cancers, 14% small-cell lung cancers and 8% other histology with a median age at treatment of 66 years. Respectively, 22.2%, 16.8% and 30.0% experienced APT, LPT and AET. In the training set (n = 117), the corresponding BAcc for clinical only/clinical + DVH/combined were 0.68/0.79/0.92, 0.66/0.77/0.87 and 0.68/0.73/0.84. In the testing evaluation (n = 50), these trained models obtained a corresponding BAcc of 0.69/0.69/0.92, 0.76/0.80/0.89 and 0.58/0.73/0.72. CONCLUSION In patients with a lung cancer treated with RT, radiomic features extracted from 3D dose maps seem to surpass usual models based on clinical factors and DVHs for the prediction of APT and LPT.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France.
| | - R Da-Ano
- LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - V Jaouen
- LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - F Lucia
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - G Dissaux
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - J Bert
- LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - O Pradier
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - D Visvikis
- LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - M Hatt
- LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
| | - U Schick
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, Univ Brest, Brest, France
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West K, Schneider M, Wright C, Beldham‐Collins R, Coburn N, Tiver K, Gebski V, Stuart KE. Radiation‐induced oesophagitis in breast cancer: Factors influencing onset and severity for patients receiving supraclavicular nodal irradiation. J Med Imaging Radiat Oncol 2019; 64:113-119. [DOI: 10.1111/1754-9485.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Katrina West
- Nepean Cancer Care Centre Nepean Blue Mountains Local Health District Penrith New South Wales Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District Wentworthville New South Wales Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
| | - Caroline Wright
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
| | - Rachael Beldham‐Collins
- Nepean Cancer Care Centre Nepean Blue Mountains Local Health District Penrith New South Wales Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District Wentworthville New South Wales Australia
| | - Natalie Coburn
- Nepean Cancer Care Centre Nepean Blue Mountains Local Health District Penrith New South Wales Australia
| | - Ken Tiver
- Nepean Cancer Care Centre Nepean Blue Mountains Local Health District Penrith New South Wales Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre University of Sydney Sydney New South Wales Australia
- Sydney Medical School The University of Sydney Sydney New South Wales Australia
| | - Kirsty E Stuart
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District Wentworthville New South Wales Australia
- Sydney Medical School The University of Sydney Sydney New South Wales Australia
- Westmead Breast Cancer Institute Westmead New South Wales Australia
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11
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Huang J, He T, Yang R, Ji T, Li G. Clinical, dosimetric, and position factors for radiation-induced acute esophagitis in intensity-modulated (chemo)radiotherapy for locally advanced non-small-cell lung cancer. Onco Targets Ther 2018; 11:6167-6175. [PMID: 30288052 PMCID: PMC6160279 DOI: 10.2147/ott.s174561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
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 chemo-radiotherapy (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.
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Affiliation(s)
- Jin Huang
- Department of Radiotherapy, The First Hospital of China Medical University, Shenyang 110001, China,
| | - Tianyu He
- Department of Radiotherapy, The First Hospital of China Medical University, Shenyang 110001, China,
| | - Ronghui Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang 110000, China
| | - Tianlong Ji
- Department of Radiotherapy, The First Hospital of China Medical University, Shenyang 110001, China,
| | - Guang Li
- Department of Radiotherapy, The First Hospital of China Medical University, Shenyang 110001, China,
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12
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Paximadis P, Schipper M, Matuszak M, Feng M, Jolly S, Boike T, Grills I, Kestin L, Movsas B, Griffith K, Gustafson G, Moran J, Nurushev T, Radawski J, Pierce L, Hayman J. Dosimetric predictors for acute esophagitis during radiation therapy for lung cancer: Results of a large statewide observational study. Pract Radiat Oncol 2018; 8:167-173. [PMID: 28919249 PMCID: PMC6818411 DOI: 10.1016/j.prro.2017.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/07/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study is to identify dosimetric variables that best predict for acute esophagitis in patients treated for locally advanced non-small cell lung cancer in a prospectively accrued statewide consortium. METHODS AND MATERIALS Patients receiving definitive radiation therapy for stage II-III non-small cell lung cancer within the Michigan Radiation Oncology Quality Consortium were included in the analysis. Dose-volume histogram data were analyzed to determine absolute volumes (cc) receiving doses from 10 to 60 Gy (V10, V20, V30, V40, V50, and V60), as well as maximum dose to 2 cc (D2cc), mean dose (MD), and generalized equivalent uniform dose (gEUD). Logistic regression models were used to characterize the risk of toxicity as a function of dose and other covariates. The ability of each variable to predict esophagitis, individually or in a multivariate model, was quantified by receiver operating characteristic analysis. RESULTS There were 533 patients who met study criteria and were included; 437 (81.9%) developed any grade of esophagitis. Significant variables on univariate analysis for grade ≥2 esophagitis were concurrent chemotherapy, V20, V30, V40, V50, V60, MD, D2cc, and gEUD. For grade ≥3 esophagitis, the predictive variables were: V30, V40, V50, V60, MD, D2cc, and gEUD. In multivariable modeling, gEUD was the most significant predictor of both grade ≥2 and grade ≥3 esophagitis. When gEUD was excluded from the model, D2cc was selected as the most predictive variable for grade ≥3 esophagitis. For an estimated risk of grade ≥3 esophagitis of 5%, the threshold values for gEUD and D2cc were 59.3 Gy and 68 Gy, respectively. CONCLUSIONS In this study, we report the novel finding that gEUD and D2cc, rather than MD, were the most predictive dose metrics for severe esophagitis. To limit the estimated risk of grade ≥3 esophagitis to <5%, thresholds of 59.3 Gy and 68 Gy were identified for gEUD and D2cc, respectively.
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Affiliation(s)
| | | | | | - Mary Feng
- University of Michigan, Ann Arbor, Michigan
| | | | | | - Inga Grills
- William Beaumont Hospital, Royal Oak, Michigan
| | - Larry Kestin
- 21st Century Oncology, Farmington Hills, Michigan
| | | | | | | | - Jean Moran
- University of Michigan, Ann Arbor, Michigan
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13
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Peyraga G, Caron D, Lizee T, Metayer Y, Septans AL, Pointreau Y, Denis F, Ganem G, Lafond C, Roche S, Dupuis O. Digestive toxicities after palliative three-dimensional conformal radiation therapy (3D-CRT) for cervico-thoracic spinal metastases. Support Care Cancer 2017; 26:1897-1903. [PMID: 29275524 DOI: 10.1007/s00520-017-4001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The palliative treatment for cervico-thoracic spinal metastases is based on a three-dimensional conformal radiation therapy (3D-CRT). Digestive toxicities are common and cause a clinical impact frequently underestimated in patients. We performed a retrospective study of digestive side effects occurring after palliative 3D-CRT for cervico-thoracic spinal metastases. PATIENTS AND METHODS All patients receiving palliative 3D-CRT at Jean Bernard Center from January 2013 to December 2014 for spinal metastases between the 5th cervical vertebra (C5) and the 12th thoracic vertebra (T12) were eligible. Three-dimensional conformal RT was delivered by a linear accelerator (CLINAC, Varian). Premedication to prevent digestive toxicities was not used. Adverse events ("esophagitis" and "nausea and/or vomiting") were evaluated according to the NCI-CTCae (version 4). RESULTS From January 2013 to December 2014, 128 patients met the study criteria. The median age was 68.6 years [31.8; 88.6]. Most patients (84.4%) received 30 Gy in 10 fractions. The median overall time of treatment was 13 days [3-33]. Forty patients (31.3%) suffered from grade ≥ 2 of "esophagitis" (35 grade 2 (27.4%) and 5 grade 3 (3.9%)). Eight patients (6.3%) suffered from grade ≥ 2 of "nausea and/or vomiting" (6 grade 2 (4.7%), 1 grade 3 (0.8%), and 1 grade 4 (0.8%)). CONCLUSION The high incidence of moderate to severe digestive toxicities after palliative 3D-CRT for cervico-thoracic spinal metastases led to consider static or dynamic intensity-modulated radiation therapy (IMRT) to reduce the dose to organ at risk (the esophagus and stomach). Dosimetric studies and implementation in the clinic should be the next steps.
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Affiliation(s)
- Guillaume Peyraga
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France.
- Department of Radiation Therapy, Integrative Center of Oncology (Paul Papin), 15 rue Bocquel, 49055, Angers Cedex 2, France.
| | - Delphine Caron
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
- Department of Radiation Therapy, Integrative Center of Oncology (Paul Papin), 15 rue Bocquel, 49055, Angers Cedex 2, France
| | - Thibaut Lizee
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
- Department of Radiation Therapy, Integrative Center of Oncology (Paul Papin), 15 rue Bocquel, 49055, Angers Cedex 2, France
| | - Yann Metayer
- Department of Medical Physics, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Anne-Lise Septans
- Department of Medical Biostatistics, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Yoann Pointreau
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Fabrice Denis
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Gerard Ganem
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Cedrik Lafond
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Sophie Roche
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
| | - Olivier Dupuis
- Department of Radiation Therapy, Jean Bernard Center, 9 Rue Beauverger, 72000, Le Mans, France
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Hawkins PG, Boonstra PS, Hobson ST, Hayman JA, Ten Haken RK, Matuszak MM, Stanton P, Kalemkerian GP, Lawrence TS, Schipper MJ, Kong FMS, Jolly S. Prediction of Radiation Esophagitis in Non-Small Cell Lung Cancer Using Clinical Factors, Dosimetric Parameters, and Pretreatment Cytokine Levels. Transl Oncol 2017; 11:102-108. [PMID: 29220828 PMCID: PMC6002355 DOI: 10.1016/j.tranon.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/15/2017] [Indexed: 12/12/2022] Open
Abstract
Radiation esophagitis (RE) is a common adverse event associated with radiotherapy for non-small cell lung cancer (NSCLC). While plasma cytokine levels have been correlated with other forms of radiation-induced toxicity, their association with RE has been less well studied. We analyzed data from 126 patients treated on 4 prospective clinical trials. Logistic regression models based on combinations of dosimetric factors [maximum dose to 2 cubic cm (D2cc) and generalized equivalent uniform dose (gEUD)], clinical variables, and pretreatment plasma levels of 30 cytokines were developed. Cross-validated estimates of area under the receiver operating characteristic curve (AUC) and log likelihood were used to assess prediction accuracy. Dose-only models predicted grade 3 RE with AUC values of 0.750 (D2cc) and 0.727 (gEUD). Combining clinical factors with D2cc increased the AUC to 0.779. Incorporating pretreatment cytokine measurements, modeled as direct associations with RE and as potential interactions with the dose-esophagitis association, produced AUC values of 0.758 and 0.773, respectively. D2cc and gEUD correlated with grade 3 RE with odds ratios (ORs) of 1.094/Gy and 1.096/Gy, respectively. Female gender was associated with a higher risk of RE, with ORs of 1.09 and 1.112 in the D2cc and gEUD models, respectively. Older age was associated with decreased risk of RE, with ORs of 0.992/year and 0.991/year in the D2cc and gEUD models, respectively. Combining clinical with dosimetric factors but not pretreatment cytokine levels yielded improved prediction of grade 3 RE compared to prediction by dose alone. Such multifactorial modeling may prove useful in directing radiation treatment planning.
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Affiliation(s)
- Peter G Hawkins
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America
| | - Stephen T Hobson
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Paul Stanton
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Gregory P Kalemkerian
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America; Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Indiana University, 535 Barnhill Drive, Indianapolis, IN 46202, United States of America
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States of America.
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15
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Dankers F, Wijsman R, Troost EGC, Monshouwer R, Bussink J, Hoffmann AL. Esophageal wall dose-surface maps do not improve the predictive performance of a multivariable NTCP model for acute esophageal toxicity in advanced stage NSCLC patients treated with intensity-modulated (chemo-)radiotherapy. Phys Med Biol 2017; 62:3668-3681. [DOI: 10.1088/1361-6560/aa5e9e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Soni PD, Boonstra PS, Schipper MJ, Bazzi L, Dess RT, Matuszak MM, Kong FM, Hayman JA, Ten Haken RK, Lawrence TS, Kalemkerian GP, Jolly S. Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer. J Thorac Oncol 2017; 12:539-546. [PMID: 28161553 DOI: 10.1016/j.jtho.2016.11.2227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients. METHODS A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database. RESULTS In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95% confidence intervals of 0.88-0.98 and 0.87-0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis. CONCLUSIONS There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.
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Affiliation(s)
- Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Latifa Bazzi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Feng-Ming Kong
- Department on Radiation Oncology, Indiana University, Indianapolis, Indiana
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Coskun H, Andic F, Daglıoglu YK, Doran F, Sahin K, Tunalı C, Kucuk O. Lycopene in the Prevention of Radiation-Induced Esophagitis. Nutr Cancer 2017; 69:319-329. [PMID: 28094572 DOI: 10.1080/01635581.2017.1265133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We aimed to research whether lycopene (L) could prevent radiation-induced acute esophageal toxicity in Wistar albino rats. 60 rats were placed in five groups as follows: control, L, radiotherapy (RT), L before RT (L + RT), and L before and after RT (L + RT + L). 6 mg/kg bw/day L was administered 7 days in the L group, 7 days before RT in the L + RT group, and 7 days before and after in the L + RT + L group. 35 Gy thoracic RT was performed. Serum L levels were measured, and the esophagi were evaluated histopathologically for intraepithelial degenerative changes-necrosis, vacuole formation, inflammation, regeneration-mitosis, and subepithelial bulla formation. L levels were significantly higher in the L receiving groups. All histopathologic results were significantly worse in the RT group than in the none-RT groups. The L + RT and the L + RT + L groups had better results than the RT group. Grade 2-3 degenerative changes-necrosis and vacuole formation were significantly lesser in the L + RT and the L + RT + L groups than those in the RT group. There was a trend toward decreased subepithelial bulla formation and inflammation in the L + RT and the L + RT + L groups compared to the RT group. Regeneration-mitosis was insignificantly lesser in the L + RT and significantly fewer in the L + RT + L groups than that in the RT group.
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Affiliation(s)
- Hatice Coskun
- a Faculty of Medicine, Department of Radiation Oncology , Cukurova University , Adana , Turkey
| | - Fundagul Andic
- a Faculty of Medicine, Department of Radiation Oncology , Cukurova University , Adana , Turkey
| | | | - Figen Doran
- c Faculty of Medicine, Department of Pathology , Cukurova University , Adana , Turkey
| | - Kazım Sahin
- d Faculty of Veterinary Science, Department of Animal Nutrition , Firat University , Elazig , Turkey
| | - Candas Tunalı
- a Faculty of Medicine, Department of Radiation Oncology , Cukurova University , Adana , Turkey
| | - Omer Kucuk
- e Department of Medicine , Winship Cancer Institute of Emory University , Atlanta , Georgia , USA
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18
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Boyle J, Ackerson B, Gu L, Kelsey CR. Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer. Adv Radiat Oncol 2017; 2:6-11. [PMID: 28740910 PMCID: PMC5514227 DOI: 10.1016/j.adro.2016.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose Radiation therapy plays an essential role in the treatment of locally advanced lung cancer, but it inevitably leads to incidental and unnecessary dose to critical organs, including the lung, heart, and esophagus. Numerous radiation dose-volumetric parameters have been associated with increased risk of morbidity and mortality. The purpose of the present study is to quantify differences in normal tissue radiation exposure with intensity modulated radiation therapy (IMRT) compared with 3-dimensional conformal radiation therapy (3D-CRT). Methods and materials Twenty-four consecutive patients with locally advanced lung cancer undergoing definitive IMRT were enrolled on a phase 1 protocol. For each patient, an optimized 3D-CRT plan was also designed. Plans were normalized in terms of planning target coverage with a standard dose of 60 Gy in 2-Gy fractions with a subset of patients also receiving elective nodal irradiation to a dose of 44 Gy in 2-Gy fractions. Normal tissue dosimetric comparisons were made for the lung, heart, and esophagus. Results IMRT decreased incidental dose to the lungs, heart, and esophagus. For lung, both V20 Gy (21.5% vs 26.5%, P < .01) and mean lung dose (11.9 Gy vs 14.9 Gy, P < .01) were improved with IMRT without a corresponding increase in V5 Gy (P = .76). For heart, there was improvement in V5 (28.9% vs 33.7%, P < .01) but no difference in V30 Gy (9.8% vs 15.9%. P = .10). For esophagus, all dosimetric endpoints were improved (V20 Gy, V45 Gy, V60 Gy, mean dose). For example, V60 was 6.5% with IMRT compared with 21% with 3D-CRT (P < .01). Conclusions IMRT significantly decreased unnecessary dose to critical organs with equivalent coverage of planning target volumes. IMRT may therefore improve the tolerability of therapy.
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Affiliation(s)
- John Boyle
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Brad Ackerson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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19
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Huang EX, Robinson CG, Molotievschi A, Bradley JD, Deasy JO, Oh JH. Independent test of a model to predict severe acute esophagitis. Adv Radiat Oncol 2016; 2:37-43. [PMID: 28740914 PMCID: PMC5514225 DOI: 10.1016/j.adro.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/28/2016] [Accepted: 11/09/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Treatment planning factors are known to affect the risk of severe acute esophagitis during thoracic radiation therapy. We tested a previously published model to predict the risk of severe acute esophagitis on an independent data set. METHODS AND MATERIALS The data set consists of data from patients who had recoverable treatment plans and received definitive radiation therapy for non-small cell carcinoma of the lung at a single institution between November 2004 and January 2010. Complete esophagus dose-volume and available clinical information was extracted using our in-house software. The previously published model was a logistic function with a combination of mean esophageal dose and use of concurrent chemotherapy. In addition to testing the previous model, we used a novel, machine learning-based method to build a maximally predictive model. RESULTS Ninety-four patients (81.7%) developed Common Terminology Criteria for Adverse Events, Version 4, Grade 2 or more severe esophagitis (Grade 2: n = 79 and Grade 3: n = 15). Univariate analysis revealed that the most statistically significant dose-volume parameters included percentage of esophagus volume receiving ≥40 to 60 Gy, minimum dose to the highest 20% of esophagus volume (D20) to D35, and mean dose. Other significant predictors included concurrent chemotherapy and patient age. The previously published model predicted risk effectively with a Spearman's rank correlation coefficient (rs) of 0.43 (P < .001) with good calibration (Hosmer-Lemeshow goodness of fit: P = .537). A new model that was built from the current data set found the same variables, yielding an rs of 0.43 (P < .001) with a logistic function of 0.0853 × mean esophageal dose [Gy] + 1.49 × concurrent chemotherapy [1/0] - 1.75 and Hosmer-Lemeshow P = .659. A novel preconditioned least absolute shrinkage and selection operator method yielded an average rs of 0.38 on 100 bootstrapped data sets. CONCLUSIONS The previously published model was validated on an independent data set and determined to be nearly as predictive as the best possible two-parameter logistic model even though it overpredicted risk systematically. A novel, machine learning-based model using a bootstrapping approach showed reasonable predictive power.
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Affiliation(s)
- Ellen X Huang
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Alerson Molotievschi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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Gong B, Jiang N, Yan G, Wang S, Deng C, Wei S, Zhao Y. Predictors for severe acute esophagitis in lung cancer patients treated with chemoradiotherapy: a systematic review. Curr Med Res Opin 2016; 32:1701-1708. [PMID: 27341659 DOI: 10.1080/03007995.2016.1205004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To identify the risk factors for severe acute esophagitis (AE) in lung cancer patients undergoing chemoradiotherapy (CRT). METHODS Articles from PubMed, EMBASE, and the Cochrane Library were searched in August 2015. Articles reporting studies of the predictors for severe AE in lung cancer patients after CRT were included. Study quality was assessed using a modified quality assessment tool that was designed previously for an observational study. The effects of studies were combined with the study quality score using a best-evidence synthesis model. Severe AE incidence was also performed using the Metafor package of R-2.11.1. RESULTS A total of nine observational studies involving 1641 patients were included. The estimated incidence of severe AE was 14%. According to the best-evidence synthesis criteria, there were two strong-evidence risk factors for severe AE, which were the use of concurrent chemotherapy (CCT) and dose volume histogram (DVH). We also identified four limited-evidence risk factors. CONCLUSIONS More attention should be paid to the levels of patients' esophagus function. Although there is no conclusive evidence for severe AE in lung cancer patients after CRT, the above-mentioned factors provide evidence to guide clinicians as to which patients will have severe AE and to choose an optimal prophylactic strategy.
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Affiliation(s)
- Bingyan Gong
- a School of Nursing , Tianjin Medical University , Tianjin , China
| | - Nan Jiang
- a School of Nursing , Tianjin Medical University , Tianjin , China
| | - Guiming Yan
- a School of Nursing , Tianjin Medical University , Tianjin , China
| | - Siyuan Wang
- a School of Nursing , Tianjin Medical University , Tianjin , China
| | - Cuiyu Deng
- a School of Nursing , Tianjin Medical University , Tianjin , China
| | - Siqi Wei
- a School of Nursing , Tianjin Medical University , Tianjin , China
| | - Yue Zhao
- a School of Nursing , Tianjin Medical University , Tianjin , China
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21
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Giraud P, Lacornerie T, Mornex F. Radiothérapie des cancers primitifs du poumon. Cancer Radiother 2016; 20 Suppl:S147-56. [DOI: 10.1016/j.canrad.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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22
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Noël G, Antoni D, Barillot I, Chauvet B. Délinéation des organes à risque et contraintes dosimétriques. Cancer Radiother 2016; 20 Suppl:S36-60. [DOI: 10.1016/j.canrad.2016.07.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Pan Y, Brink C, Knap M, Khalil AA, Nyhus CH, McCulloch T, Holm B, Wu YL, Schytte T, Hansen O. Acute esophagitis for patients with local-regional advanced non small cell lung cancer treated with concurrent chemoradiotherapy. Radiother Oncol 2016; 118:465-70. [PMID: 26803187 DOI: 10.1016/j.radonc.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/08/2016] [Accepted: 01/10/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Esophagitis is common in patients treated with definitive radiotherapy for local-regional advanced non small cell lung cancer (NSCLC). The purpose of this study was to estimate the dose-effect relationship using clinical and dosimetric parameters in patients receiving intensity modulated radiotherapy (IMRT) and concomitant chemotherapy (CCT). METHODS Between 2009 and 2013, 117 patients with stages IIB-IIIB NSCLC were treated in a multicenter randomized phase II trial with 2 cycles of induction chemotherapy followed by IMRT and CCT. The esophagitis was prospectively scored using the Common Toxicity Criteria 3.0. Clinical and dosimetric variables were analyzed for the correlation with grade ⩾2 esophagitis through logistic regression. RESULTS Grade 2 esophagitis was experienced by 31 (27%). All models including gender, institution, a dosimetric parameter and a position parameter were significantly associated with esophagitis. The two models using the relative esophagus volume irradiated above 40 Gy (V40, OR=2.18/10% volume) or the length of esophagus irradiated above 40 Gy (L40, OR=4.03/5 cm) were optimal. The upper part of esophagus was more sensitive and females experienced more toxicity than men. CONCLUSION V40 and L40 were most effective dosimetric predictors of grade ⩾2 esophagitis. The upper part of esophagus was more sensitive.
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Affiliation(s)
- Yi Pan
- Department of Radiation Oncology, Guangdong General Hospital & Guangdong Academy of Medical Science, PR China; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Brink
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - Marianne Knap
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Azza A Khalil
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Christa H Nyhus
- Department of Oncology, Vejle Hospital, Sygehus Lillebaelt, Denmark
| | - Tine McCulloch
- Department of Oncology, Aalborg University Hospital, Denmark
| | - Bente Holm
- Department of Oncology, Herlev University Hospital, Denmark
| | - Yi-long Wu
- Guangdong Lung Cancer Institute, PR China
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Denmark
| | - Olfred Hansen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark.
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Wijsman R, Dankers F, Troost EGC, Hoffmann AL, van der Heijden EHFM, de Geus-Oei LF, Bussink J. Multivariable normal-tissue complication modeling of acute esophageal toxicity in advanced stage non-small cell lung cancer patients treated with intensity-modulated (chemo-)radiotherapy. Radiother Oncol 2015; 117:49-54. [PMID: 26341608 DOI: 10.1016/j.radonc.2015.08.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The majority of normal-tissue complication probability (NTCP) models for acute esophageal toxicity (AET) in advanced stage non-small cell lung cancer (AS-NSCLC) patients treated with (chemo-)radiotherapy are based on three-dimensional conformal radiotherapy (3D-CRT). Due to distinct dosimetric characteristics of intensity-modulated radiation therapy (IMRT), 3D-CRT based models need revision. We established a multivariable NTCP model for AET in 149 AS-NSCLC patients undergoing IMRT. MATERIALS AND METHODS An established model selection procedure was used to develop an NTCP model for Grade ⩾2 AET (53 patients) including clinical and esophageal dose-volume histogram parameters. RESULTS The NTCP model predicted an increased risk of Grade ⩾2 AET in case of: concurrent chemoradiotherapy (CCR) [adjusted odds ratio (OR) 14.08, 95% confidence interval (CI) 4.70-42.19; p<0.001], increasing mean esophageal dose [Dmean; OR 1.12 per Gy increase, 95% CI 1.06-1.19; p<0.001], female patients (OR 3.33, 95% CI 1.36-8.17; p=0.008), and ⩾cT3 (OR 2.7, 95% CI 1.12-6.50; p=0.026). The AUC was 0.82 and the model showed good calibration. CONCLUSIONS A multivariable NTCP model including CCR, Dmean, clinical tumor stage and gender predicts Grade ⩾2 AET after IMRT for AS-NSCLC. Prior to clinical introduction, the model needs validation in an independent patient cohort.
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Affiliation(s)
- Robin Wijsman
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Frank Dankers
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther G C Troost
- Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Germany; Department of Radiotherapy and Radiooncology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany; OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany
| | - Aswin L Hoffmann
- Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Germany; Department of Radiotherapy and Radiooncology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | | | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, The Netherlands; Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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Zehentmayr F, Söhn M, Exeli AK, Wurstbauer K, Tröller A, Deutschmann H, Fastner G, Fussl C, Steininger P, Kranzinger M, Belka C, Studnicka M, Sedlmayer F. Normal tissue complication models for clinically relevant acute esophagitis (≥ grade 2) in patients treated with dose differentiated accelerated radiotherapy (DART-bid). Radiat Oncol 2015; 10:121. [PMID: 26018527 PMCID: PMC4450607 DOI: 10.1186/s13014-015-0429-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/25/2015] [Indexed: 12/13/2022] Open
Abstract
Background One of the primary dose-limiting toxicities during thoracic irradiation is acute esophagitis (AE). The aim of this study is to investigate dosimetric and clinical predictors for AE grade ≥ 2 in patients treated with accelerated radiotherapy for locally advanced non-small cell lung cancer (NSCLC). Patients and methods 66 NSCLC patients were included in the present analysis: 4 stage II, 44 stage IIIA and 18 stage IIIB. All patients received induction chemotherapy followed by dose differentiated accelerated radiotherapy (DART-bid). Depending on size (mean of three perpendicular diameters) tumors were binned in four dose groups: <2.5 cm 73.8 Gy, 2.5–4.5 cm 79.2 Gy, 4.5–6 cm 84.6 Gy, >6 cm 90 Gy. Patients were treated in 3D target splitting technique. In order to estimate the normal tissue complication probability (NTCP), two Lyman models and the cutoff-logistic regression model were fitted to the data with AE ≥ grade 2 as statistical endpoint. Inter-model comparison was performed with the corrected Akaike information criterion (AICc), which calculates the model’s quality of fit (likelihood value) in relation to its complexity (i.e. number of variables in the model) corrected by the number of patients in the dataset. Toxicity was documented prospectively according to RTOG. Results The median follow up was 686 days (range 84–2921 days), 23/66 patients (35 %) experienced AE ≥ grade 2. The actuarial local control rates were 72.6 % and 59.4 % at 2 and 3 years, regional control was 91 % at both time points. The Lyman-MED model (D50 = 32.8 Gy, m = 0.48) and the cutoff dose model (Dc = 38 Gy) provide the most efficient fit to the current dataset. On multivariate analysis V38 (volume of the esophagus that receives 38 Gy or above, 95 %-CI 28.2–57.3) was the most significant predictor of AE ≥ grade 2 (HR = 1.05, CI 1.01–1.09, p = 0.007). Conclusion Following high-dose accelerated radiotherapy the rate of AE ≥ grade 2 is slightly lower than reported for concomitant radio-chemotherapy with the additional benefit of markedly increased loco-regional tumor control. In the current patient cohort the most significant predictor of AE was found to be V38. A second clinically useful parameter in treatment planning may be MED (mean esophageal dose). Electronic supplementary material The online version of this article (doi:10.1186/s13014-015-0429-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franz Zehentmayr
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria. .,Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Matthias Söhn
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Ann-Katrin Exeli
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Karl Wurstbauer
- Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Almut Tröller
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Department of Radiation Oncology, William Beaumont Health System, 3601 W. Thirteen Mile Road, Royal Oak, MI, 48073, USA.
| | - Heinz Deutschmann
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria. .,Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Gerd Fastner
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Christoph Fussl
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Philipp Steininger
- Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Manfred Kranzinger
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Claus Belka
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Michael Studnicka
- Univ.-Klinik für Pneumologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Felix Sedlmayer
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria. .,Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
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Treatment-related acute esophagitis for patients with locoregionally advanced non-small cell lung cancer treated with involved-field radiotherapy and concurrent chemotherapy. Am J Clin Oncol 2014; 37:433-7. [PMID: 23388558 DOI: 10.1097/coc.0b013e31827de7a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To explore the incidence and risk factors for treatment-related acute esophagitis associated with involved-field radiation therapy (RT) delivered concurrently with chemotherapy for patients with locoregionally advanced non-small cell lung cancer. MATERIALS AND METHODS Forty-nine consecutive patients diagnosed with locoregionally advanced non-small cell lung cancer were treated using involved-field RT. Radiotherapy target volumes included the primary lung tumor and involved mediastinal lymphadenopathy as defined on imaging studies including computed tomography of the chest and fluorodeoxyglucose-positron emission tomography/computed tomography. The patients were treated to a median total dose of 63 Gy (range, 55.8 to 74 Gy) using daily fractions of 1.8 or 2.0 Gy. No elective radiotherapy of mediastinal lymph nodes was used. Concurrent platinum-based chemotherapy was delivered to all patients. Treatment-related toxicity was evaluated during the course of RT and subsequent follow-up visits. RESULTS Thirty-one (63%) patients were female and 18 (37%) were male. Median age at the time of diagnosis was 68 years (range, 36 to 83 y). Thirty-one patients (63%) developed treatment-related acute esophagitis: 24 patients (49%) grade 2 and 7 (14%) patients grade 3 esophagitis, with the peak occurring during the seventh week of radiotherapy. No grade ≥ 4 esophagitis was seen in this cohort. Eighteen patients (37%) did not develop radiation-induced esophagitis associated with their course of chemoradiotherapy. In the univariate analysis, age at the time of diagnosis, radiation dose per fraction, and total volume of the esophagus were significantly associated with the risk of acute esophagitis. Increasing age reduced the risk of acute esophagitis (odds ratio [OR] for 10-y increase = 0.40) as did increasing total esophagus volume (OR for 10-U increase = 0.27). Dose per fraction of 1.8 Gy was associated with lower risk of acute esophagitis when compared with dose per fraction of 2 Gy (OR = 0.19). Marginal associations were observed for all of the volume variables. Higher volume variable values had a nonsignificant association with an increase in risk of acute esophagitis. However, only the total volume of the esophagus (P = 0.0032) and larger dose per fraction (2 vs. 1.8 Gy) (P = 0.011) remained significantly associated with higher risk of developing grade ≥ 2 acute esophagitis in the multivariate analysis. CONCLUSIONS Higher risk of grade ≥ 2 treatment-related esophagitis was associated with lower total esophageal volume and higher radiotherapy dose per fraction and should be taken into consideration during patient treatment planning. Inclusion of total esophageal volume and dose per fraction into future clinical protocols may further help our understanding of treatment-related esophagitis and enable the development of novel preventative approaches.
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Gomez D, Liao Z, Saintigny P, Komaki RU. Combinations of Radiation Therapy and Chemotherapy for Non-Small Cell and Small-Cell Lung Carcinoma. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Palma DA, Senan S, Oberije C, Belderbos J, de Dios NR, Bradley JD, Barriger RB, Moreno-Jiménez M, Kim TH, Ramella S, Everitt S, Rengan R, Marks LB, De Ruyck K, Warner A, Rodrigues G. Predicting esophagitis after chemoradiation therapy for non-small cell lung cancer: an individual patient data meta-analysis. Int J Radiat Oncol Biol Phys 2013; 87:690-6. [PMID: 24035329 DOI: 10.1016/j.ijrobp.2013.07.029] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/25/2013] [Accepted: 07/25/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Concurrent chemoradiation therapy (CCRT) improves survival compared with sequential treatment for locally advanced non-small cell lung cancer, but it increases toxicity, particularly radiation esophagitis (RE). Validated predictors of RE for clinical use are lacking. We performed an individual-patient-data meta-analysis to determine factors predictive of clinically significant RE. METHODS AND MATERIALS After a systematic review of the literature, data were obtained on 1082 patients who underwent CCRT, including patients from Europe, North America, Asia, and Australia. Patients were randomly divided into training and validation sets (2/3 vs 1/3 of patients). Factors predictive of RE (grade≥2 and grade≥3) were assessed using logistic modeling, with the concordance statistic (c statistic) used to evaluate the performance of each model. RESULTS The median radiation therapy dose delivered was 65 Gy, and the median follow-up time was 2.1 years. Most patients (91%) received platinum-containing CCRT regimens. The development of RE was common, scored as grade 2 in 348 patients (32.2%), grade 3 in 185 (17.1%), and grade 4 in 10 (0.9%). There were no RE-related deaths. On univariable analysis using the training set, several baseline factors were statistically predictive of RE (P<.05), but only dosimetric factors had good discrimination scores (c>.60). On multivariable analysis, the esophageal volume receiving ≥60 Gy (V60) alone emerged as the best predictor of grade≥2 and grade≥3 RE, with good calibration and discrimination. Recursive partitioning identified 3 risk groups: low (V60<0.07%), intermediate (V60 0.07% to 16.99%), and high (V60≥17%). With use of the validation set, the predictive model performed inferiorly for the grade≥2 endpoint (c=.58) but performed well for the grade≥3 endpoint (c=.66). CONCLUSIONS Clinically significant RE is common, but life-threatening complications occur in <1% of patients. Although several factors are statistically predictive of RE, the V60 alone provides the best predictive ability. Efforts to reduce the V60 should be prioritized, with further research needed to identify and validate new predictive factors.
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Affiliation(s)
- David A Palma
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
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Niedzielski J, Bluett JB, Williamson RT, Liao Z, Gomez DR, Court LE. Analysis of esophageal-sparing treatment plans for patients with high-grade esophagitis. J Appl Clin Med Phys 2013; 14:4248. [PMID: 23835390 PMCID: PMC5714525 DOI: 10.1120/jacmp.v14i4.4248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/25/2013] [Accepted: 03/14/2013] [Indexed: 12/25/2022] Open
Abstract
We retrospectively generated IMRT plans for 14 NSCLC patients who had experienced grade 2 or 3 esophagitis (CTCAE version 3.0). We generated 11-beam and reduced esophagus dose plan types to compare changes in the volume and length of esophagus receiving doses of 50, 55, 60, 65, and 70 Gy. Changes in planning target volume (PTV) dose coverage were also compared. If necessary, plans were renormalized to restore 95% PTV coverage. The critical organ doses examined were mean lung dose, mean heart dose, and volume of spinal cord receiving 50 Gy. The effect of interfractional motion was determined by applying a three-dimensional rigid shift to the dose grid. For the esophagus plan, the mean reduction in esophagus V50, V55, V60, V65, and V70 Gy was 2.8, 4.1, 5.9, 7.3, and 9.5 cm(3), respectively, compared with the clinical plan. The mean reductions in LE50, LE55, LE60, LE65, and LE70 Gy were 2.0, 3.0, 3.8, 4.0, and 4.6 cm, respectively. The mean heart and lung dose decreased 3.0 Gy and 2.4 Gy, respectively. The mean decreases in 90% and 95% PTV coverage were 1.7 Gy and 2.8 Gy, respectively. The normalized plans' mean reduction of esophagus V50, V55, V60, V65, and V70 Gy were 1.6, 2.0, 2.9, 3.9, and 5.5 cm(3), respectively, compared with the clinical plans. The normalized plans' mean reductions in LE50, LE55, LE60, LE65, and LE70 Gy were 4.9, 5.2, 5.4, 4.9, and 4.8 cm, respectively. The mean reduction in maximum esophagus dose with simulated interfractional motion was 3.0 Gy and 1.4 Gy for the clinical plan type and the esophagus plan type, respectively. In many cases, the esophagus dose can be greatly reduced while maintaining critical structure dose constraints. PTV coverage can be restored by increasing beam output, while still obtaining a dose reduction to the esophagus and maintaining dose constraints.
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Affiliation(s)
- Joshua Niedzielski
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Ding X, Li H, Wang Z, Huang W, Li B, Zang R, Sun H, Yi Y. A Clinical Study of Shrinking Field Radiation Therapy Based on 18F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2013; 12:251-7. [PMID: 23289475 DOI: 10.7785/tcrt.2012.500310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim is to investigate the feasibility of shrinking field technique after 40 Gy for stage III non-small cell lung cancer (NSCLC) during radiation therapy. Eighty-seven consecutive patients treated with intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were enrolled in this study. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scanning was performed prior to treatment and repeated after 40 Gy, and the delineation of target volume was based on fused images of PET and CT. After 40 Gy of conventional fractionated radiotherapy to the initial planning target volume (PTV), a boost of 19.6–39.2 Gy was delivered to the shrunken PTV through late course accelerated hyperfractionated radiotherapy, and the median total dose was 66.0 Gy (range, 59.6–79.2 Gy). Gross tumor volume (GTV) and PTV regressions were recorded, and prescription doses with or without shrinking field were calculated. Local recurrence patterns were investigated through follow-up. The tumor volumes regressed in 84 (96.6%) patients and increased in 3 (3.4%) patients after 40 Gy. The mean GTV and PTV reduction was 38% (range, −13–95%) and 30% (range, −5–95%). Mean total prescription dose escalated from 62.0 Gy to 68.5 Gy through shrinking field technique. The median follow-up was 17 months, ranging from 5 to 46 months, and the 1- and 2-year overall survival rates in our study were 74.7% and 34.6%. The response rate was 79.5%, and radiation toxicity was acceptable. Tumor progression occurred in 67.8% (59/87) patients. Numbers of patients who had outfield, infield and both infield and outfield recurrences were 3 (3.4%), 26 (29.5%), and 3 (3.4%), respectively. In conclusion, significant tumor regression was observed after 40 Gy, and radiation dose escalated after shrinking field with acceptable toxicity and outfield relapse. Shrinking field radiotherapy based on 18F-FDG PET/CT after 40 Gy was safe and feasible for stage III NSCLC.
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Affiliation(s)
- Xiuping Ding
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Rukun Zang
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, P.R. China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Yan Yi
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
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Yin LJ, Yu XB, Ren YG, Gu GH, Ding TG, Lu Z. Utilization of PET-CT in target volume delineation for three-dimensional conformal radiotherapy in patients with non-small cell lung cancer and atelectasis. Multidiscip Respir Med 2013; 8:21. [PMID: 23506629 PMCID: PMC3608960 DOI: 10.1186/2049-6958-8-21] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/04/2013] [Indexed: 11/15/2022] Open
Abstract
Background To investigate the utilization of PET-CT in target volume delineation for three-dimensional conformal radiotherapy in patients with non-small cell lung cancer (NSCLC) and atelectasis. Methods Thirty NSCLC patients who underwent radical radiotherapy from August 2010 to March 2012 were included in this study. All patients were pathologically confirmed to have atelectasis by imaging examination. PET-CT scanning was performed in these patients. According to the PET-CT scan results, the gross tumor volume (GTV) and organs at risk (OARs, including the lungs, heart, esophagus and spinal cord) were delineated separately both on CT and PET-CT images. The clinical target volume (CTV) was defined as the GTV plus a margin of 6-8 mm, and the planning target volume (PTV) as the GTV plus a margin of 10-15mm. An experienced physician was responsible for designing treatment plans PlanCT and PlanPET-CT on CT image sets. 95% of the PTV was encompassed by the 90% isodose curve, and the two treatment plans kept the same beam direction, beam number, gantry angle, and position of the multi-leaf collimator as much as possible. The GTV was compared using a target delineation system, and doses distributions to OARs were compared on the basis of dose-volume histogram (DVH) parameters. Results The GTVCT and GTVPET-CT had varying degrees of change in all 30 patients, and the changes in the GTVCT and GTVPET-CT exceeded 25% in 12 (40%) patients. The GTVPET-CT decreased in varying degrees compared to the GTVCT in 22 patients. Their median GTVPET-CT and median GTVPET-CT were 111.4 cm3 (range, 37.8 cm3-188.7 cm3) and 155.1 cm3 (range, 76.2 cm3-301.0 cm3), respectively, and the former was 43.7 cm3 (28.2%) less than the latter. The GTVPET-CT increased in varying degrees compared to the GTVCT in 8 patients. Their median GTVPET-CT and median GTVPET-CT were 144.7 cm3 (range, 125.4 cm3-178.7 cm3) and 125.8 cm3 (range, 105.6 cm3-153.5 cm3), respectively, and the former was 18.9 cm3 (15.0%) greater than the latter. Compared to PlanCT parameters, PlanPET-CT parameters showed varying degrees of changes. The changes in lung V20, V30, esophageal V50 and V55 were statistically significant (Ps< 0.05 for all), while the differences in mean lung dose, lung V5, V10, V15, heart V30, mean esophageal dose, esophagus Dmax, and spinal cord Dmax were not significant (Ps> 0.05 for all). Conclusions PET-CT allows a better distinction between the collapsed lung tissue and tumor tissue, improving the accuracy of radiotherapy target delineation, and reducing radiation damage to the surrounding OARs in NSCLC patients with atelectasis.
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Affiliation(s)
- Li-Jie Yin
- Department of Radiotherapy, Dalian Central Hospital, Dalian 116033, China.
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Kuroda Y, Sekine I, Sumi M, Sekii S, Takahashi K, Inaba K, Horinouchi H, Nokihara H, Yamamoto N, Kubota K, Murakami N, Morota M, Mayahara H, Ito Y, Tamura T, Nemoto K, Itami J. Acute radiation esophagitis caused by high-dose involved field radiotherapy with concurrent cisplatin and vinorelbine for stage III non-small cell lung cancer. Technol Cancer Res Treat 2013; 12:333-9. [PMID: 23369154 DOI: 10.7785/tcrt.2012.500319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose of this study is to obtain dose-volume histogram (DVH) predictors and threshold values for radiation esophagitis caused by high-dose involved field radiotherapy (IFRT) with concurrent chemotherapy in patients with stage III non-small cell lung cancer (NSCLC). Thirty-two patients treated by 66 Gy/33 Fr, 72 Gy/36 Fr, and 78 Gy/39 Fr thoracic radiotherapy without elective nodal irradiation plus concurrent cisplatin and vinorelvine were reviewed. Acute radiation esophagitis was evaluated according to common terminology criteria for adverse events version 4.0, and correlations between grade 2 or worse radiation esophagitis and DVH parameters were investigated. Grade 0-1, 2, 3, and 4-5 of radiation esophagitis were seen in 11 (34.4%), 20 (62.5%), 1 (3.1%), and 0 (0%) of the patients, respectively. Multivariate analysis revealed that whole esophagus V35 is a predictor of radiation esophagitis (OR = 0.74 [95%CI; 0.60-0.91], p = 0.006). There is a significant difference (38.4% vs. 89.4%, p = 0.027) in the cumulative rates of acute esophagitis according to V35 values of more than 20% versus less. As compared with other factors concerning patient and tumor and treatment factors, V35 ≤ 20% of the esophagus was an independent predictor (HR 5 0.29 [95%CI; 0.09-0.85], p 5 0.025). In conclusion, whole esophagus V35 < 20% is proposed in high-dose IFRT with concurrent chemotherapy for stage III NSCLC patients.
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Affiliation(s)
- Yuuki Kuroda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
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Nijkamp J, Rossi M, Lebesque J, Belderbos J, van den Heuvel M, Kwint M, Uyterlinde W, Vogel W, Sonke JJ. Relating acute esophagitis to radiotherapy dose using FDG-PET in concurrent chemo-radiotherapy for locally advanced non-small cell lung cancer. Radiother Oncol 2012; 106:118-23. [PMID: 23219463 DOI: 10.1016/j.radonc.2012.09.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/24/2012] [Accepted: 09/29/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To correlate radiotherapy (RT) dose to acute esophagitis (AE) by means of FDG-PET scans acquired after concurrent chemo-radiotherapy (cCRT) for locally advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS Patients treated with 24 × 2.75 Gy were selected on presence of a post-RT PET (PET(post)) scan acquired within 3 months after cCRT. The value of PET(post) in relation to AE was evaluated by comparing the mean esophageal SUV of the highest 50% (mathematical left angle bracket SUV(50%) mathematical right angle bracket) between gr < 2 and gr ≥ 2AE. The local dose on the esophagus wall was correlated to the SUV and modeled using a power-law fit. The Lyman-Kutcher-Burman (LKB) model was used to predict gr ≥ 2AE. The local dose-response relation was used in the LKB model to calculate the EUD. Resulting prediction accuracy was compared to D(mean), V(35), V(55) and V(60). RESULTS Eighty-two patients were included (gr < 2 = 25, gr ≥ 2=57). The mathematical left angle bracket SUV(50%) mathematical right angle bracket ≥ was significantly higher for gr ≥ 2AE (2.2 vs. 2.6, p < 0.01). The LKB parameters (95% CI) were n = 0.130 (0.120-0.141), m = 0.25 (0.13-0.85) and TD(50) = 50.4 Gy (37.5-55.4), which resulted in improved predictability of AE compared to other predictors. CONCLUSION Esophageal uptake of FDG post-cCRT reflects AE severity. Predictability of grade ≥ 2AE was improved by using the local dose-SUV response model, with narrow confidence intervals for the optimized LKB parameters.
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Affiliation(s)
- Jasper Nijkamp
- Department of Radiation Oncoloyg, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Bar-Ad V, Ohri N, Werner-Wasik M. Esophagitis, treatment-related toxicity in non-small cell lung cancer. Rev Recent Clin Trials 2012; 7:31-5. [PMID: 21864251 DOI: 10.2174/157488712799363235] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Radiation esophagitis represents a significant complication experienced by non-small cell cancer (NSCLC) patients receiving thoracic irradiation. The objective of the current review was to assess the clinical and dosimetrical parameters that may predict radiation esophagitis. METHODS Studies were identified by searching PubMed electronic databases. Both prospective and retrospective studies were included. Information regarding clinical and dosimetrical parameters predicting for radiation-induced esophagitis was extracted and analyzed. RESULTS The esophageal clinical and dosimetric parameters that best predict acute esophagitis remain unclear. In many reports, Vx (the volume of esophagus receiving x Gy) stands out, with values of x ranging from 20-70 Gy. Other studies conclude that the maximal dose received by any point of the esophagus is the best predictor of esophagitis. Another metric implicated with esophageal toxicity in some reports is the proportion of the esophageal circumference or surface area that receives high doses of radiation. CONCLUSIONS Technological advancements in patient immobilization, setup verification, and radiotherapy delivery are increasingly being employed to limit the toxicity of thoracic irradiation. Future efforts are required to determine how these complex techniques should best be implemented to minimize the risks of acute and long-term esophageal injury.
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Affiliation(s)
- Voichita Bar-Ad
- Thomas Jefferson University Hospital, Department of Radiation Oncology, 111 South 11th Street, Philadelphia, PA 19107, USA.
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Challand T, Thureau S, Dubray B, Giraud P. [Esophageal toxicity of radiation therapy: clinical risk factors and management]. Cancer Radiother 2012; 16:364-71. [PMID: 22925486 DOI: 10.1016/j.canrad.2012.07.180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/05/2012] [Indexed: 12/25/2022]
Abstract
Acute radiation-induced esophagitis includes all clinical symptoms (odynophagia, dysphagia) occurring within 90 days after thoracic irradiation start. Its severity can be graded using RTOG and CTCAE scales. The clinical risk factors are: age, female gender, initial performance status, pre-therapeutic body mass index, pre-therapeutic dysphagia, tumoral and nodal stage, delivered dose, accelerated hyperfractionned radiotherapy, concomitant association of chemotherapy to radiotherapy and response to the treatment. The dosimetric parameters predictive of esophagitis are: mean dose, V(20Gy), V(30Gy), V(40Gy), V(45Gy) and V(50Gy). Amifostine is the only drug to have a proven radioprotective efficacy (evidence level C, ESMO recommendation grade III). The medical management of esophagitis associates a diet excluding irritant food, medication against gastroesophageal reflux, analgesic treatment according to the WHO scale and management of dehydration and denutrition by enteral feeding.
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Affiliation(s)
- T Challand
- Département de radiothérapie et de physique médicale, QuantIF, Litis, centre Henri-Becquerel, Rouen, France.
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Ding XP, Zhang J, Li BS, Li HS, Wang ZT, Yi Y, Sun HF, Wang DQ. Feasibility of Shrinking Field Radiation Therapy through 18F-FDG PET/CT after 40 Gy for Stage III Non-Small Cell Lung Cancers. Asian Pac J Cancer Prev 2012; 13:319-323. [DOI: 10.7314/apjcp.2012.13.1.319] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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De Ruyck K, Sabbe N, Oberije C, Vandecasteele K, Thas O, De Ruysscher D, Lambin P, Van Meerbeeck J, De Neve W, Thierens H. Development of a Multicomponent Prediction Model for Acute Esophagitis in Lung Cancer Patients Receiving Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:537-44. [DOI: 10.1016/j.ijrobp.2011.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/08/2011] [Indexed: 11/15/2022]
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Cartier L, Auberdiac P, Khodri M, Malkoun N, Chargari C, Thorin J, Mélis A, Talabard JN, de Laroche G, Fournel P, Tiffet O, Schmitt T, Magné N. Correlation of dosimetric parameters obtained with the analytical anisotropic algorithm and toxicity of chest chemoradiation in lung carcinoma. Med Dosim 2011; 37:152-6. [PMID: 21925864 DOI: 10.1016/j.meddos.2011.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/15/2011] [Accepted: 06/23/2011] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to analyze and revisit toxicity related to chest chemoradiotherapy and to correlate these side effects with dosimetric parameters obtained using analytical anisotropic algorithm (AAA) in locally unresectable advanced lung cancer. We retrospectively analyzed data from 47 lung cancer patients between 2005 and 2008. All received conformal 3D radiotherapy using high-energy linear accelerator plus concomitant chemotherapy. All treatment planning data were transferred into Eclipse 8.05 (Varian Medical Systems, Palo Alto, CA) and dosimetric calculations were performed using AAA. Thirty-three patients (70.2%) developed acute pneumopathy after radiotherapy (grades 1 and 2). One patient (2.1%) presented with grade 3 pneumopathy. Thirty-one (66%) presented with grades 1-2 lung fibrosis, and 1 patient presented with grade 3 lung fibrosis. Thirty-four patients (72.3%) developed grade 1-2 acute oesophagic toxicity. Four patients (8.5%) presented with grades 3 and 4 dysphagia, necessitating prolonged parenteral nutrition. Median prescribed dose was 64 Gy (range 50-74) with conventional fractionation (2 Gy per fraction). Dose-volume constraints were respected with a median V20 of 23.5% (maximum 34%) and a median V30 of 17% (maximum 25%). The median dose delivered to healthy contralateral lung was 13.1 Gy (maximum 18.1 Gy). At univariate analysis, larger planning target volume and V20 were significantly associated with the probability of grade ≥2 radiation-induced pneumopathy (p = 0.022 and p = 0.017, respectively). No relation between oesophagic toxicity and clinical/dosimetric parameters could be established. Using AAA, the present results confirm the predictive value of the V20 for lung toxicity as already demonstrated with the conventional pencil beam convolution approach.
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Affiliation(s)
- Lysian Cartier
- Dèpartement de Radiothérapie, Institut de Cancérologie de la Loire, St-Priest en Jarez, France
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Huang EX, Bradley JD, El Naqa I, Hope AJ, Lindsay PE, Bosch WR, Matthews JW, Sause WT, Graham MV, Deasy JO. Modeling the risk of radiation-induced acute esophagitis for combined Washington University and RTOG trial 93-11 lung cancer patients. Int J Radiat Oncol Biol Phys 2011; 82:1674-9. [PMID: 21658856 DOI: 10.1016/j.ijrobp.2011.02.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 02/15/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To construct a maximally predictive model of the risk of severe acute esophagitis (AE) for patients who receive definitive radiation therapy (RT) for non-small-cell lung cancer. METHODS AND MATERIALS The dataset includes Washington University and RTOG 93-11 clinical trial data (events/patients: 120/374, WUSTL = 101/237, RTOG9311 = 19/137). Statistical model building was performed based on dosimetric and clinical parameters (patient age, sex, weight loss, pretreatment chemotherapy, concurrent chemotherapy, fraction size). A wide range of dose-volume parameters were extracted from dearchived treatment plans, including Dx, Vx, MOHx (mean of hottest x% volume), MOCx (mean of coldest x% volume), and gEUD (generalized equivalent uniform dose) values. RESULTS The most significant single parameters for predicting acute esophagitis (RTOG Grade 2 or greater) were MOH85, mean esophagus dose (MED), and V30. A superior-inferior weighted dose-center position was derived but not found to be significant. Fraction size was found to be significant on univariate logistic analysis (Spearman R = 0.421, p < 0.00001) but not multivariate logistic modeling. Cross-validation model building was used to determine that an optimal model size needed only two parameters (MOH85 and concurrent chemotherapy, robustly selected on bootstrap model-rebuilding). Mean esophagus dose (MED) is preferred instead of MOH85, as it gives nearly the same statistical performance and is easier to compute. AE risk is given as a logistic function of (0.0688 MED+1.50 ConChemo-3.13), where MED is in Gy and ConChemo is either 1 (yes) if concurrent chemotherapy was given, or 0 (no). This model correlates to the observed risk of AE with a Spearman coefficient of 0.629 (p < 0.000001). CONCLUSIONS Multivariate statistical model building with cross-validation suggests that a two-variable logistic model based on mean dose and the use of concurrent chemotherapy robustly predicts acute esophagitis risk in combined-data WUSTL and RTOG 93-11 trial datasets.
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Affiliation(s)
- Ellen X Huang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
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40
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Werner-Wasik M, Paulus R, Curran WJ, Byhardt R. Acute esophagitis and late lung toxicity in concurrent chemoradiotherapy trials in patients with locally advanced non-small-cell lung cancer: analysis of the radiation therapy oncology group (RTOG) database. Clin Lung Cancer 2011; 12:245-51. [PMID: 21726824 DOI: 10.1016/j.cllc.2011.03.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/23/2010] [Accepted: 01/28/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND We analyzed time course and factors associated with acute esophagitis (ES) and late lung toxicity (PN), as well as any association between ES and PN in patients (pts) with non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiation (chemo-RT) on the Radiation Therapy Oncology Group (RTOG) trials. MATERIALS AND METHODS Multivariable analysis was used to investigate factors associated with ES or PN. RESULTS Patients (n = 528) received standard fractionated (SFX; 63 Gy) or hyperfractionated (HFX; 69.6 Gy) radiation therapy (RT) with cisplatin-based chemotherapy. Grade > 2 ES developed in 75% of pts; Grade > 3 ES, in 34%. Nineteen percent of pts developed ES by the first, 32% by the second, and 33% by the third month (and for Grade > 3 PN, 9% by 6 months, 15% by year 1, and 18% by year 2). Any PN developed in 59% of pts; Grade > 2, in 39%; Grade > 3, in 18%; and lethal PN, in 2%. Grade > 2 PN was associated with increasing RT dose and Grade > 3 PN, with HFX RT. No association was seen with ES. Grade > 3 ES was less likely to occur in non-whites and more likely, in pts treated with HFX RT. CONCLUSION Most (95%) pts developed ES, and 33% had severe ES, peaking within the first or second month of RT. PN developed in 57% of pts, with 18% experiencing Grade > 3 PN, with most diagnosed by 1 year from RT. No relationship was observed between 1 toxicity (ES or PN) as predictor of the other. HFX RT was associated with more severe PN or ES.
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Affiliation(s)
- Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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41
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Development, external validation and clinical usefulness of a practical prediction model for radiation-induced dysphagia in lung cancer patients. Radiother Oncol 2010; 97:455-61. [DOI: 10.1016/j.radonc.2010.09.028] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/23/2010] [Accepted: 09/26/2010] [Indexed: 12/31/2022]
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Zhu J, Zhang ZC, Li BS, Liu M, Yin Y, Yu JM, Luo LM, Shu HZ, De Crevoisier R. Analysis of acute radiation-induced esophagitis in non-small-cell lung cancer patients using the Lyman NTCP model. Radiother Oncol 2010; 97:449-54. [PMID: 21067834 DOI: 10.1016/j.radonc.2010.09.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 09/22/2010] [Accepted: 09/26/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze acute esophagitis (AE) in a Chinese population receiving 3D conformal radiotherapy (3DCRT) for non-small cell lung cancer (NSCLC), combined or not with chemotherapy (CT), using the Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) model. MATERIALS AND METHODS 157 Chinese patients (pts) presented with NSCLC received 3DCRT: alone (34 pts) or combined with sequential CT (59 pts) (group 1) or with concomitant CT (64 pts) (group 2). Parameters (TD(50), n, and m) of the LKB NTCP model predicting for>grade 2 AE (RTOG grading) were identified using maximum likelihood analysis. Univariate and multivariate analyses using a binary regression logistic model were performed to identify patient, tumor and dosimetric predictors of AE. RESULTS Grade 2 or 3 AE occurred in 24% and 52% of pts in group 1 and 2, respectively (p<0.001). For the 93 group 1 pts, the fitted LKB model parameters were: m=0.15, n=0.29 and TD(50)=46 Gy. For the 64 group 2 pts, the parameters were: m=0.42, n=0.09 and TD(50)=36 Gy. In multivariate analysis, the only significant predictors of AE were: NTCP (p<0.001) and V(50), as continuous variable (RR=1.03, p=0.03) or being more than a threshold value of 11% (RR=3.6, p=0.009). CONCLUSIONS A LKB NTCP model has been established to predict AE in a Chinese population, receiving thoracic RT, alone or combined with CT. The parameters of the models appear slightly different than the previous one described in Western countries, with a lower volume effect for Chinese patients.
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Affiliation(s)
- Jian Zhu
- Laboratory of Image Science and Technology, Southeast University, Nanjing, PR China
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López Rodríguez M, Martín Martín M, Cerezo Padellano L, Marín Palomo A, Ibáñez Puebla Y. Gastrointestinal toxicity associated to radiation therapy. Clin Transl Oncol 2010; 12:554-61. [DOI: 10.1007/s12094-010-0553-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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45
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Caglar HB, Othus M, Allen AM. Esophagus in-field: A new predictor for esophagitis. Radiother Oncol 2010; 97:48-53. [DOI: 10.1016/j.radonc.2010.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Revised: 06/09/2010] [Accepted: 07/18/2010] [Indexed: 12/25/2022]
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46
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Bera G, Pointreau Y, Denis F, Orain I, Dupuis O, Créhange G. Dose de tolérance à l’irradiation des tissus sains : l’œsophage. Cancer Radiother 2010; 14:327-35. [DOI: 10.1016/j.canrad.2010.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/02/2010] [Indexed: 12/26/2022]
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Clinical and dosimetric risk factors of acute esophagitis in patients treated with 3-dimensional conformal radiotherapy for non-small-cell lung cancer. Am J Clin Oncol 2010; 33:271-5. [PMID: 19823071 DOI: 10.1097/coc.0b013e3181a879e0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze the clinical and dosimetric risk factors of acute esophagitis (AE) in non-small-cell lung cancer (NSCLC) patients treated with 3-dimensional conformal radiotherapy (3D-CRT). METHODS AND MATERIALS One hundred two NSCLC patients treated with 3D-CRT were retrospectively analyzed. Forty of these 102 patients analyzed were treated with concurrent chemotherapy (CCT). The median biologic effective dose of radiotherapy was 72.0 Gy. AE was scored according to the Radiation Therapy Oncology Group criteria. The clinical and dosimetric factors associated with grade 2 or worse AE were analyzed using univariate and multivariate binary logistic analysis. RESULTS There were no grade 4 or 5 AE observed in the 102 patients analyzed. Thirty-four of 102 patients (33.3%) developed grade 2 or 3 AE. Univariate analysis showed that clinical factors, such as lymph nodes stage (N 0/1 vs. N 2/3), pretreatment weight loss > or =5%, CCT, and the use of late-course hyperfractionated radiotherapy were significantly associated with grade 2 and 3 AE. Dose volume parameters of esophagus including mean esophageal dose, maximal esophageal dose, rV15, rV20, rV25, rV30, rV35, rV40, rV45, rV50, rV55, rV60 were also associated with AE. On multivariate forward step-wise logistic analysis, CCT, lymph nodes stage, and rV55 emerged as the statistically most significant factors of AE with OR parameters of 8.911, 4.832, and 1.083, respectively. CONCLUSION CCT, lymphatic status, and rV55 were strong predictors of grade 2 or worse AE in NSCLC treated with 3D-CRT.
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Alevronta E, Ahlberg A, Mavroidis P, al-Abany M, Friesland S, Tilikidis A, Laurell G, Lind BK. Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy. Radiother Oncol 2010; 97:54-9. [PMID: 20557965 DOI: 10.1016/j.radonc.2010.04.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 04/19/2010] [Accepted: 04/25/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Determination of the dose-response relations for oesophageal stricture after radiotherapy of the head and neck. MATERIAL AND METHODS In this study 33 patients who developed oesophageal stricture and 39 patients as controls are included. The patients received radiation therapy for head and neck cancer at Karolinska University Hospital, Stockholm, Sweden. For each patient the 3D dose distribution delivered to the upper 5 cm of the oesophagus was analysed. The analysis was conducted for two periods, 1992-2000 and 2001-2005, due to the different irradiation techniques used. The fitting has been done using the relative seriality model. RESULTS For the treatment period 1992-2005, the mean doses were 49.8 and 33.4 Gy, respectively, for the cases and the controls. For the period 1992-2000, the mean doses for the cases and the controls were 49.9 and 45.9 Gy and for the period 2001-2005 were 49.8 and 21.4 Gy. For the period 2001-2005 the best estimates of the dose-response parameters are D(50)=61.5 Gy (52.9-84.9 Gy), γ=1.4 (0.8-2.6) and s=0.1 (0.01-0.3). CONCLUSIONS Radiation-induced strictures were found to have a dose response relation and volume dependence (low relative seriality) for the treatment period 2001-2005. However, no dose response relation was found for the complete material.
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Affiliation(s)
- Eleftheria Alevronta
- Department of Oncology-Pathology, Division of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
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González JA, Chust M, Delgado R, Gómez A, Rodríguez N, Ruiz MJ, Casas F. Spanish radiobiological pattern of care in lung cancer: a GOECP/SEOR study. Clin Transl Oncol 2010; 12:292-8. [PMID: 20462839 DOI: 10.1007/s12094-010-0506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION A survey regarding radiobiological questions in the treatment of lung cancer (LC) was done to study the clinical aspects of radiotherapy in Spain, in order to standardise treatment decisions. METHODS AND MATERIALS From November 2007 to March 2008, a survey was performed among radiation oncologists in Spain specialising in LC treatment via e-mail, which included questions regarding different radiobiological aspects of radiotherapy LC treatment. The extent of the resulting material made it necessary to divide it into two parts; the first is presented in this article. The second, which includes items about alpha/beta-NTCP/TCP values and reirradiation criteria, will be reported elsewhere. RESULTS Thirty-one radiation therapists from 29 radiation oncology departments answered the survey. 77.4-93.5% of responders used the basic formula from the linear-quadratic model and/or computer software for radiobiological calculations; 100% used lung (mostly V20, median <30%) and spinal cord constraints (mostly a median of physical maximum dose <45.5 Gy); and 90.3% used heart and oesophagus constraints (very heterogeneous parameters in both organs). CONCLUSIONS Radiobiological considerations are clearly present in the planning process of radiotherapy of LC in Spain, with a high coincidence with the literature regarding lung and spinal cord constraints. The heterogeneity shown for oesophagus and heart results demonstrates the need for continuing investigation into the standardisation of clinical, dosimetric and radiobiologic aspects of the treatment of this cancer.
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Affiliation(s)
- J A González
- Department of Radiation Oncology, Instituto Madrileño de Oncología Unidad Regional de Guadalajara, Guadalajara, Spain.
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Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB. Radiation dose-volume effects in the esophagus. Int J Radiat Oncol Biol Phys 2010; 76:S86-93. [PMID: 20171523 DOI: 10.1016/j.ijrobp.2009.05.070] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 04/30/2009] [Accepted: 05/02/2009] [Indexed: 12/12/2022]
Abstract
Publications relating esophageal radiation toxicity to clinical variables and to quantitative dose and dose-volume measures derived from three-dimensional conformal radiotherapy for non-small-cell lung cancer are reviewed. A variety of clinical and dosimetric parameters have been associated with acute and late toxicity. Suggestions for future studies are presented.
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Affiliation(s)
- Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5097, USA.
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