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Wang DQ, Zhang N, Dong LH, Zhong YH, Wu HF, Zhong QZ, Jin J, Hou XR, Jing H, Tang Y, Hu C, Song YW, Liu YP, Qi SN, Tang Y, Lu NN, Chen B, Zhai YR, Zhang WW, Li N, Fang H, Li YX, Wang SL. Dose-Volume Predictors for Radiation Esophagitis in Patients With Breast Cancer Undergoing Hypofractionated Regional Nodal Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:186-197. [PMID: 37001764 DOI: 10.1016/j.ijrobp.2023.03.060] [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: 12/10/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Our objective was to assess the incidence and dose-volume predictors of radiation esophagitis (RE) in patients with breast cancer undergoing hypofractionated regional nodal irradiation. METHODS AND MATERIALS Eligible patients who received intensity modulated radiation therapy (RT) at the chest wall, the supraclavicular/infraclavicular fossa, level II axilla, and/or the internal mammary chain after mastectomy were included. The prescribed dose was 43.5 Gy in 15 fractions. RE was evaluated weekly during RT and at 1 and 2 weeks, followed by 3 and 6 months after RT, and was graded according to National Cancer Institute Common Toxicity Criteria for Adverse Events, version 3.0. The esophagus was contoured from the lower border level of the cricoid cartilage to the lower margin of the aortic arch. Esophageal total volume, mean dose, maximum dose, and the relative volumes (RV) and absolute volumes (AV) receiving at least 5 to 45 Gy by 5-Gy increments (RV5-RV45 and AV5-AV45) were evaluated. Univariable and multivariable logistic regression analyses were performed to determine risk factors for RE, and receiver operating characteristic curves were obtained to identify the thresholds of esophageal dosimetric parameters. RESULTS In total, 298 patients were included between May 8, 2020, and January 5, 2022 (minimum post-RT follow-up: 6 months). Grade 2 and 3 RE incidence was 40.9% (122/298) and 0.3% (1/298), respectively. No grade 4 or 5 RE was observed. Esophageal RV20-RV40 and AV35-AV40 were significantly associated with the risk of grade ≥2 RE after adjusting for tumor laterality and internal mammary nodal irradiation. RV25 and AV35 were optimum dose-volume predictors for grade ≥2 RE at thresholds 20% for RV25 (35.9% vs 60.9%; P = .04) and 0.27 mL for AV35 (31.0% vs 54.6%; P = .04). CONCLUSIONS RE is common in patients with breast cancer undergoing hypofractionated regional nodal irradiation. Maintaining the upper esophageal V25 at <20% and V35 at <0.27 mL may decrease the risk of RE.
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Affiliation(s)
- Dan-Qiong Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Zhang
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Li-Hua Dong
- Department of Radiation Oncology, First Hospital, Jilin University, Changchun, China
| | - Ya-Hua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, China
| | - Hong-Fen Wu
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, China
| | - Qiu-Zi Zhong
- Department of Radiation Oncology, Beijing Hospital, Ministry of Health, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiao-Rong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Rui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Hoppen L, Sarria GR, Kwok CS, Boda-Heggemann J, Buergy D, Ehmann M, Giordano FA, Fleckenstein J. Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer. Radiat Oncol 2023; 18:34. [PMID: 36814271 PMCID: PMC9945670 DOI: 10.1186/s13014-023-02222-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Daily adaptive radiation therapy (ART) of patients with non-small cell lung cancer (NSCLC) lowers organs at risk exposure while maintaining the planning target volume (PTV) coverage. Thus, ART allows an isotoxic approach with increased doses to the PTV that could improve local tumor control. Herein we evaluate daily online ART strategies regarding their impact on relevant dose-volume metrics. METHODS Daily cone-beam CTs (1 × n = 28, 1 × n = 29, 11 × n = 30) of 13 stage III NSCLC patients were converted into synthetic CTs (sCTs). Treatment plans (TPs) were created retrospectively on the first-fraction sCTs (sCT1) and subsequently transferred unaltered to the sCTs of the remaining fractions of each patient (sCT2-n) (IGRT scenario). Two additional TPs were generated on sCT2-n: one minimizing the lung-dose while preserving the D95%(PTV) (isoeffective scenario), the other escalating the D95%(PTV) with a constant V20Gy(lungipsilateral) (isotoxic scenario). RESULTS Compared to the original TPs predicted dose, the median D95%(PTV) in the IGRT scenario decreased by 1.6 Gy ± 4.2 Gy while the V20Gy(lungipsilateral) increased in median by 1.1% ± 4.4%. The isoeffective scenario preserved the PTV coverage and reduced the median V20Gy(lungipsilateral) by 3.1% ± 3.6%. Furthermore, the median V5%(heart) decreased by 2.9% ± 6.4%. With an isotoxic prescription, a median dose-escalation to the gross target volume of 10.0 Gy ± 8.1 Gy without increasing the V20Gy(lungipsilateral) and V5%(heart) was feasible. CONCLUSIONS We demonstrated that even without reducing safety margins, ART can reduce lung-doses, while still reaching adequate target coverage or escalate target doses without increasing ipsilateral lung exposure. Clinical benefits by means of toxicity and local control of both strategies should be evaluated in prospective clinical trials.
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Affiliation(s)
- Lea Hoppen
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Gustavo R. Sarria
- grid.10388.320000 0001 2240 3300Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Chung S. Kwok
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Judit Boda-Heggemann
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Daniel Buergy
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael Ehmann
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank A. Giordano
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Jens Fleckenstein
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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3
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Ma C, Tian Z, Wang R, Feng Z, Jiang F, Hu Q, Yang F, Shi A, Wu H. A prediction model for dosimetric-based lung adaptive radiotherapy. Med Phys 2022; 49:6319-6333. [PMID: 35649103 DOI: 10.1002/mp.15714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/22/2022] [Accepted: 05/01/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Anatomical changes occurred during the treatment course of radiation therapy for lung cancer patients may introduce clinically unacceptable dosimetric deviations from the planned dose. Adaptive radiotherapy (ART) can compensate these dosimetric deviations in subsequent treatments via plan adaption. Determining whether and when to trigger plan adaption during the treatment course is essential to the effectiveness and efficiency of ART. In this study, we aimed to develop a prediction model as an auxiliary decision-making tool for lung ART to identify the patients with intrathoracic anatomical changes that would potentially benefit from the plan adaptions during the treatment course. METHODS Seventy-one pairs of weekly cone-beam computer tomography (CBCT) and planning CT (pCT) from 17 advanced non-small cell lung cancer patients were enrolled in this study. To assess the dosimetric impacts brought by anatomical changes observed on each CBCT, dose distribution of the original treatment plan on the CBCT anatomy was calculated on a virtual CT generated by deforming the corresponding pCT to the CBCT, and compared to that of the original plan. A replan was deemed needed for the CBCT anatomy once the recalculated dose distribution violated our dosimetric-based trigger criteria. A three-dimensional region of significant anatomical changes (region of interest, ROI) between each CBCT and the corresponding pCT was identified and 16 morphological features of the ROI were extracted. Additionally, eight features from the overlapped volume histograms (OVHs) of patient anatomy were extracted for each patient to characterize the patient specific anatomy. Based on the 24 extracted features and the evaluated replanning needs of the pCT-CBCT pairs, a nonlinear supporting vector machine was used to build a prediction model to identify the anatomical changes on CBCTs that would trigger plan adaptions. The most relevant features were selected using the sequential backward selection (SBS) algorithm and a shuffling-and-splitting validation scheme was used for model evaluation. RESULTS Fifty-Five CBCT-pCT pairs were identified of having a ROI, among which 21 CBCT anatomies required plan adaptions. For these 21 positive cases, statistically significant improvements in the sparing of lung, esophagus and spinal cord were achieved by plan adaptions. A high model performance of 0.929 AUC and 0.851 accuracy was achieved with six selected features including five ROI shape features and one OVH feature. Without involving the OVH features in the feature selection process, the mean AUC and accuracy of the model significantly decreased to 0.826 and 0.779, respectively. Further investigation showed that poor prediction performance with AUC of 0.76 was achieved by the univariate model in solving this binary classification task. CONCLUSION We built a prediction model based on the features of patient anatomy and the anatomical changes captured by on-treatment CBCT imaging to trigger plan adaption for lung cancer patients. This model effectively associated the anatomical changes with the dosimetric impacts for lung ART. This model can be a promising tool to assist the clinicians in making decisions for plan adaptions during the treatment courses. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chaoqiong Ma
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.,Department of Radiation Oncology, Emory University, Atlanta, GA, 30322, USA
| | - Zhen Tian
- Department of Radiation Oncology, Emory University, Atlanta, GA, 30322, USA.,Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, 60637, USA
| | - Ruoxi Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhongsu Feng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Fan Jiang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Qiaoqiao Hu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Fang Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.,Department of Oncology, Daqing Oilfield General Hospital, Daqing, 163001, China
| | - Anhui Shi
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Hao Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.,Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
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4
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Lin MQ, Wu YH, Yang J, Lin HC, Liu LY, Yu YL, Yao QW, Li JC. Gut Microbiota Characteristics Are Associated With Severity of Acute Radiation-Induced Esophagitis. Front Microbiol 2022; 13:883650. [PMID: 35756007 PMCID: PMC9218355 DOI: 10.3389/fmicb.2022.883650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute radiation-induced esophagitis (ARIE) is one of the most debilitating complications in patients who receive thoracic radiotherapy, especially those with esophageal cancer (EC). There is little known about the impact of the characteristics of gut microbiota on the initiation and severity of ARIE. MATERIALS AND METHODS Gut microbiota samples of EC patients undergoing radiotherapy (n = 7) or concurrent chemoradiotherapy (n = 42) were collected at the start, middle, and end of the radiotherapy regimen. Assessment of patient-reported ARIE was also performed. Based on 16S rRNA gene sequencing, changes of the gut microbial community during the treatment regimen and correlations of the gut microbiota characteristics with the severity of ARIE were investigated. RESULTS There were significant associations of several properties of the gut microbiota with the severity of ARIE. The relative abundance of several genera in the phylum Proteobacteria increased significantly as mucositis severity increased. The predominant genera had characteristic changes during the treatment regimen, such as an increase of opportunistic pathogenic bacteria including Streptococcus. Patients with severe ARIE had significantly lower alpha diversity and a higher abundance of Fusobacterium before radiotherapy, but patients with mild ARIE were enriched in Klebsiella, Roseburia, Veillonella, Prevotella_9, Megasphaera, and Ruminococcus_2. A model combining these genera had the best performance in prediction of severe ARIE (area under the curve: 0.907). CONCLUSION The characteristics of gut microbiota before radiotherapy were associated with subsequent ARIE severity. Microbiota-based strategies have potential use for the early prediction of subsequent ARIE and for the selection of interventions that may prevent severe ARIE.
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Affiliation(s)
- Ming-qiang Lin
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Ya-hua Wu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Jun Yang
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Han-cui Lin
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Ling-yun Liu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Yi-lin Yu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Qi-wei Yao
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
- *Correspondence: Qi-wei Yao,
| | - Jian-cheng Li
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
- Jian-cheng Li,
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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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Hamada K, Itoh T, Kawaura K, Kuno H, Kamai J, Kobayasi R, Azukisawa S, Kitakata H, Ishisaka T, Igarashi Y, Kodera K, Okuno T, Morita T, Himeno T, Yano H, Higashikawa T, Iritani O, Iwai K, Morimoto S, Matoba M, Okuro M. A Case of Refractory Esophageal Ulcer Caused by Radiotherapy for Hepatocellular Carcinoma. World J Oncol 2021; 12:67-72. [PMID: 34046101 PMCID: PMC8139740 DOI: 10.14740/wjon1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
A 77-year-old man who underwent radiotherapy for hepatocellular carcinoma 6 months prior consulted for esophageal obstruction. Esophagogastroduodenoscopy revealed an esophageal ulcer caused by radiotherapy for hepatocellular carcinoma. He was treated with dietary counseling and vonoprazan. After 9 months, the ulcer improved but a moderate stenosis remained. Several factors such as high fraction size, history of chemotherapy, and stress associated with food intake might involve in the development of a radiation-associated ulcer. Opportunities to choose radiotherapy for hepatocellular carcinoma may increase, so we hypothesize that esophageal ulcers might be a complication that should be noted associated with this therapy.
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Affiliation(s)
- Kazu Hamada
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.,Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Tohru Itoh
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Ken Kawaura
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Kuno
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Junji Kamai
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Rika Kobayasi
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Sadahumi Azukisawa
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Hidekazu Kitakata
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Taishi Ishisaka
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Yuta Igarashi
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Kumie Kodera
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Tazuo Okuno
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Takuro Morita
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Tarou Himeno
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroshi Yano
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | | | - Osamu Iritani
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Kunimitsu Iwai
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Shigeto Morimoto
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Munetaka Matoba
- Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
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7
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Yaney A, Ayan AS, Pan X, Jhawar S, Healy E, Beyer S, Lindsey K, Kuhn K, Tedrick K, White JR, Bazan JG. Dosimetric parameters associated with radiation-induced esophagitis in breast cancer patients undergoing regional nodal irradiation. Radiother Oncol 2020; 155:167-173. [PMID: 33157173 DOI: 10.1016/j.radonc.2020.10.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE Rates of acute esophagitis in breast cancer patients undergoing regional nodal irradiation (RNI) are under-reported. We set to identify esophageal dose-volume constraints associated with grade 2 esophagitis (G2E). We hypothesized that the G2E rate was higher with intensity modulated radiation therapy (IMRT) vs. 3D conformal radiation therapy (3DCRT). MATERIALS/METHODS We identified patients that received RNI (50 Gy/25 fractions) from 1/2013 to 6/2019. We retrospectively contoured the esophagus in a consistent manner and recorded esophageal mean dose, max dose, and V10-V50. Our primary endpoint was the G2E rate. Receiver operating characteristics curves analysis (e.g., Youden's J statistic) were used to determine the cutpoints for the dosimetric parameters which were then tested in logistic regression models. RESULTS We identified 531 patients (50% left-sided; 41% IMRT; 16.2% G2E). G2E was significantly higher in IMRT vs. 3DCRT patients (23.6% vs. 10.9%, p < 0.0001). All esophageal dosimetric parameters were significantly associated with G2E after adjusting for age and laterality. The cutpoints for esophageal mean dose, V10 and V20 were 11 Gy, 30%, and 15%, respectively. The associations between the dichotomized dose-volume parameters and G2E were OR = 3.82 (95% CI 2.28-6.40, p < 0.0001) for esophageal mean dose, OR = 5.37 (95% CI 3.01-9.58, p < 0.0001) for esophageal V10, and OR = 3.23 (95% CI 1.93-5.41, p < 0.0001) for esophageal V20. CONCLUSION In patients receiving RNI with modern techniques, we found that G2E occurs in >15%, and more frequently with IMRT. These data strongly support the routine contouring of the esophagus in RNI planning, and our constraints should be incorporated in future prospective protocols of RNI.
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Affiliation(s)
- Alexander Yaney
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Ahmet S Ayan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State University, Columbus, USA.
| | - Sachin Jhawar
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Erin Healy
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Kylee Lindsey
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Karla Kuhn
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Kayla Tedrick
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Julia R White
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
| | - Jose G Bazan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, USA.
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8
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Xu L, Li Y, Sun S, Yue J. Decrease of oral microbial diversity might correlate with radiation esophagitis in patients with esophageal cancer undergoing chemoradiation: A pilot study. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lei Xu
- School of Medicine Shandong University Jinan Shandong China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
| | - Yan Li
- Department of Disease Control and Prevention Huaiyin District Center for Disease Control and Prevention Jinan Shandong China
| | - Shichang Sun
- Department of Medical Oncology Jining Cancer Hospital Jining Shandong China
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
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9
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von Reibnitz D, Yorke ED, Oh JH, Apte AP, Yang J, Pham H, Thor M, Wu AJ, Fleisher M, Gelb E, Deasy JO, Rimner A. Predictive Modeling of Thoracic Radiotherapy Toxicity and the Potential Role of Serum Alpha-2-Macroglobulin. Front Oncol 2020; 10:1395. [PMID: 32850450 PMCID: PMC7423838 DOI: 10.3389/fonc.2020.01395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background: To investigate the impact of alpha-2-macroglobulin (A2M), a suspected intrinsic radioprotectant, on radiation pneumonitis and esophagitis using multifactorial predictive models. Materials and Methods: Baseline A2M levels were obtained for 258 patients prior to thoracic radiotherapy (RT). Dose-volume characteristics were extracted from treatment plans. Spearman's correlation (Rs) test was used to correlate clinical and dosimetric variables with toxicities. Toxicity prediction models were built using least absolute shrinkage and selection operator (LASSO) logistic regression on 1,000 bootstrapped datasets. Results: Grade ≥2 esophagitis and pneumonitis developed in 61 (23.6%) and 36 (14.0%) patients, respectively. The median A2M level was 191 mg/dL (range: 94-511). Never/former/current smoker status was 47 (18.2%)/179 (69.4%)/32 (12.4%). We found a significant negative univariate correlation between baseline A2M levels and esophagitis (Rs = -0.18/p = 0.003) and between A2M and smoking status (Rs = 0.13/p = 0.04). Further significant parameters for grade ≥2 esophagitis included age (Rs = -0.32/p < 0.0001), chemotherapy use (Rs = 0.56/p < 0.0001), dose per fraction (Rs = -0.57/p < 0.0001), total dose (Rs = 0.35/p < 0.0001), and several other dosimetric variables with Rs > 0.5 (p < 0.0001). The only significant non-dosimetric parameter for grade ≥2 pneumonitis was sex (Rs = -0.32/p = 0.037) with higher risk for women. For pneumonitis D15 (lung) (Rs = 0.19/p = 0.006) and D45 (heart) (Rs = 0.16/p = 0.016) had the highest correlation. LASSO models applied on the validation data were statistically significant and resulted in areas under the receiver operating characteristic curve of 0.84 (esophagitis) and 0.78 (pneumonitis). Multivariate predictive models did not require A2M to reach maximum predictive power. Conclusion: This is the first study showing a likely association of higher baseline A2M values with lower risk of radiation esophagitis and with smoking status. However, the baseline A2M level was not a significant risk factor for radiation pneumonitis.
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Affiliation(s)
- Donata von Reibnitz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ellen D Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Aditya P Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jie Yang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hai Pham
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Martin Fleisher
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Emily Gelb
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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10
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Journy N, Schonfeld SJ, Hauptmann M, Roberti S, Howell RM, Smith SA, Vaalavirta L, Stovall M, van Leeuwen FE, Weathers RE, Hodgson D, Gilbert ES, Berrington de Gonzalez A, Morton LM. Dose-volume effects of breast cancer radiation therapy on the risk of second oesophageal cancer. Radiother Oncol 2020; 151:33-39. [PMID: 32679305 DOI: 10.1016/j.radonc.2020.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/15/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the relationship between oesophagus dose-volume distribution and long-term risk of oesophageal cancer after radiation therapy for breast cancer. MATERIALS AND METHODS In a case-control study nested within a cohort of 289,748 ≥5-year survivors of female breast cancer treated in 1943-2003 in five countries, doses to the second primary cancer (DSPC) and individual dose-volume histograms (DVH) to the entire oesophagus were reconstructed for 252 oesophageal cancer cases and 488 matched controls (median follow-up time: 13, range: 5-37 years). Using conditional logistic regression, we estimated excess odds ratios (EOR) of oesophageal cancer associated with DVH metrics. We also investigated whether DVH metrics confounded or modified DSPC-related -risk estimates. RESULTS Among the DVH metrics evaluated, median dose (Dmedian) to the entire oesophagus had the best statistical performance for estimating risk of all histological types combined (EOR/Gy = 0.071, 95% confidence interval [CI]: 0.018 to 0.206). For squamous cell carcinoma, the most common subtype, the EOR/Gy for Dmedian increased by 31% (95% CI: 3% to 205%) for each increment of 10% of V30 (p = 0.02). Adjusting for DVH metrics did not materially change the EOR/Gy for DSPC, but there was a borderline significant positive interaction between DSPC and V30 (p = 0.07). CONCLUSION This first study investigating the relationship between oesophagus dose-volume distribution and oesophageal cancer risk showed an increased risk per Gy for Dmedian with larger volumes irradiated at high doses. While current techniques allows better oesophagus sparing, constraints applied to Dmedian and V30 could potentially further reduce the risk of oesophageal cancer.
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Affiliation(s)
- Neige Journy
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Laboratory "Radiation Epidemiology & Cancer Survivorship", Gustave Roussy Cancer Campus, Villejuif, France.
| | - Sara J Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Susan A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Leila Vaalavirta
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rita E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
| | - Ethel S Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
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11
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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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12
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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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13
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Brodin NP, Tomé WA. Revisiting the dose constraints for head and neck OARs in the current era of IMRT. Oral Oncol 2018; 86:8-18. [PMID: 30409324 DOI: 10.1016/j.oraloncology.2018.08.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 12/25/2022]
Abstract
Head and neck cancer poses a particular challenge in radiation therapy, whilst being an effective treatment modality it requires very high doses of radiation to provide effective therapy. This is further complicated by the fact that the head and neck region contains a large number of radiosensitive tissues, often resulting in patients experiencing debilitating normal tissue complications. In the era of intensity-modulated radiation therapy (IMRT) treatments can be delivered using non-uniform dose distributions selectively aimed at reducing the dose to critical organs-at-risk while still adequately covering the tumor target. Dose-volume constraints for the different risk organs play a vital role in one's ability to devise the best IMRT treatment plan for a head and neck cancer patient. To this end, it is pivotal to have access to the latest and most relevant dose constraints available and as such the goal of this review is to provide a summary of suggested dose-volume constraints for head and neck cancer RT that have been published after the QUANTEC reports were made available in early 2010.
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Affiliation(s)
- N Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Wolfgang A Tomé
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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14
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Gangadharan A, Choi SE, Hassan A, Ayoub NM, Durante G, Balwani S, Kim YH, Pecora A, Goy A, Suh KS. Protein calorie malnutrition, nutritional intervention and personalized cancer care. Oncotarget 2017; 8:24009-24030. [PMID: 28177923 PMCID: PMC5410360 DOI: 10.18632/oncotarget.15103] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/23/2017] [Indexed: 12/27/2022] Open
Abstract
Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of <50% of recommended intake for 2 weeks or more; bedridden or otherwise significantly reduced functional capacity; weight loss of >2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of the effort to alleviate effects of malnutrition on quality of life and survival of patients.
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Affiliation(s)
- Anju Gangadharan
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Sung Eun Choi
- Department of Family, Nutrition, and Exercise Sciences, Queens College, The City University of New York, Flushing, NY, USA
| | - Ahmed Hassan
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Nehad M Ayoub
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Gina Durante
- Department of Clinical Nutrition, Baystate Medical Center, Springfield, MA, USA
| | - Sakshi Balwani
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Young Hee Kim
- Department of Clinical Nutrition, Baystate Medical Center, Springfield, MA, USA
| | - Andrew Pecora
- Clinical Divisions, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Andre Goy
- Clinical Divisions, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - K Stephen Suh
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
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15
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Huang BT, Huang RH, Zhang WZ, Lin W, Guo LJ, Xu LY, Lin PX, Chen JZ, Li DR, Chen CZ. Different definitions of esophagus influence esophageal toxicity prediction for esophageal cancer patients administered simultaneous integrated boost versus standard-dose radiation therapy. Sci Rep 2017; 7:120. [PMID: 28273921 PMCID: PMC5427902 DOI: 10.1038/s41598-017-00168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/13/2017] [Indexed: 02/05/2023] Open
Abstract
We aim to evaluate whether different definitions of esophagus (DEs) impact on the esophageal toxicity prediction for esophageal cancer (EC) patients administered intensity-modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) vs. standard-dose IMRT (SD-IMRT). The esophagus for 21 patients diagnosed with primary EC were defined in the following four ways: the whole esophagus, including the tumor (ESOwhole); ESOwhole within the treatment field (ESOinfield); ESOinfield, excluding the tumor (ESOinfield-tumor) and ESOwhole, excluding the tumor (ESOwhole-tumor). The difference in the dose variation, acute esophageal toxicity (AET) and late esophageal toxicity (LET) of four DEs were compared. We found that the mean esophageal dose for ESOwhole, ESOinfield, ESOinfield-tumor and ESOwhole-tumor were increased by 7.2 Gy, 10.9 Gy, 4.6 Gy and 2.0 Gy, respectively, in the SIB-IMRT plans. Radiobiological models indicated that a grade ≥ 2 AET was 2.9%, 3.1%, 2.2% and 1.6% higher on average with the Kwint model and 14.6%, 13.2%, 7.2% and 3.4% higher with the Wijsman model for the four DEs. A grade ≥ 3 AET increased by 4.3%, 7.2%, 4.2% and 1.2%, respectively. Additionally, the predicted LET increased by 0.15%, 0.39%, 1.2 × 10−2% and 1.5 × 10−3%. Our study demonstrates that different DEs influence the esophageal toxicity prediction for EC patients administered SIB-IMRT vs. SD-IMRT treatment.
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Affiliation(s)
- Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Rui-Hong Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Wu-Zhe Zhang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Wen Lin
- Department of Respiratory Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Long-Jia Guo
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Liang-Yu Xu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Pei-Xian Lin
- Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jian-Zhou Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.,CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - De-Rui Li
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Chuang-Zhen Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
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16
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Shields H, Li J, Pelletier S, Wang H, Freedman R, Mamon H, Ng A, Freedman A, Come S, Avigan D, Huberman M, Recht A. Persistence of dysphagia and odynophagia after mediastinal radiation and chemotherapy in patients with lung cancer or lymphoma. Dis Esophagus 2017; 30:1-8. [PMID: 27247116 DOI: 10.1111/dote.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal symptoms are common during radiation and chemotherapy. It is unclear how often these symptoms persist after therapy. We retrospectively reviewed medical records of 320 adults treated for nonmetastatic breast cancer (84), lung cancer (109), or Hodgkin and non-Hodgkin lymphoma (127) who were disease-free at 10-14 months after therapy. Treatment included chemotherapy with or without nonmediastinal radiation therapy (150 patients), chemotherapy plus sequential mediastinal radiation therapy (MRT) (48 patients), chemotherapy plus concurrent MRT (61 patients), or non-MRT only (61 patients). Proton pump inhibitor use was documented. All treatment groups had similar prevalence of the esophageal symptom of heartburn before therapy. Rates were higher during treatment in those who received MRT with or without chemotherapy, but declined by 10-14 months after treatment. However, low baseline rates of dysphagia (4%) and odynophagia (2%) increased significantly after combined chemotherapy and MRT to 72% for dysphagia and 62% for odynophagia (P < 0.01) during treatment and stayed significantly elevated over baseline with 27% of the patients having dysphagia and 11% having odynophagia at 10-14 months after treatment. The use of proton pump inhibitors by patients who had MRT with chemotherapy was significantly increased during and after treatment (P = 0.002). Dysphagia, odynophagia and the use of proton pump inhibitors were significantly more common both during and after treatment than before treatment in patients who received both chemotherapy and mediastinal radiation. Our data highlight the important challenge for clinicians of managing patients with lung cancer and lymphoma who have persistent esophageal problems, particularly dysphagia and odynophagia, at approximately 1 year after treatment.
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Affiliation(s)
- Helen Shields
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Justin Li
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Helen Wang
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rachel Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Harvey Mamon
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea Ng
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Arnold Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven Come
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David Avigan
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mark Huberman
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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17
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Bernard ME, Glaser SM, Gill BS, Beriwal S, Heron DE, Luketich JD, Friedland DM, Socinski MA, Greenberger JS. Results of a Single Institution Experience with Dose-Escalated Chemoradiation for Locally Advanced Unresectable Non-Small Cell Lung Cancer. Front Oncol 2017; 7:1. [PMID: 28168163 PMCID: PMC5253386 DOI: 10.3389/fonc.2017.00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 01/05/2017] [Indexed: 12/25/2022] Open
Abstract
Background We determined factors associated with morbidity and outcomes of a series of non-small cell lung cancer (NSCLC) patients treated with dose-escalated chemoradiotherapy at the University of Pittsburgh Lung Cancer Program. Methods and materials The records of 170 stage III NSCLC patients treated with definitive intent were retrospectively reviewed. All patients received four-dimensional CT simulation scan and had respiratory gating if tumor movement exceeded 5 mm. Overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FFDM) were calculated using log-rank and Cox regression analysis. Results For the present series of patients, median follow-up was 36.6 months, median survival 27.4 months, and the 2- and 4-year OS was 56.0 and 30.7%, respectively. The 4-year LRC and FFDM were 43.9 and 40.7%, respectively. No benefit was associated with irradiation doses above 66 Gy in OS (p = 0.586), LRC (p = 0.440), or FFDM (p = 0.230). On univariate analysis, variables associated with worse survival included: clinical stage IIIB (p = 0.037), planning target volume (PTV) over 450 cc (p < 0.001), heart V30 over 40% (p = −0.048), and esophageal mean dose over 20% (p = 0.024), V5 (p = −0.015), and V60 (p = −0.011). On multivariable analysis, PTV above 450 cc (52.2 vs. 25.3 months, p < 0.001) and esophageal V60 >20% (43.8 vs. 21.3 months, p = −0.01) were associated with lower survival. Grade 2 or higher acute lung toxicity and esophagitis were detected in 9.5 and 59.7%, respectively of patients. Grade 2 or higher acute lung toxicity was reduced if lung V5 was ≤65 (7.4 vs. 23.8%, p = 0.03). Grade 2 or higher acute esophagitis was reduced if V60 ≤ 20% (62 vs. 81.3%, p = 0.018). The use of intensity-modulated radiation therapy was more frequent in stage IIIB compared to stage IIIA patients (56.5 vs. 39.5%, p = 0.048) and was associated with a higher lung V5 and V10. Conclusion The outcomes of a program of dose-escalated chemoradiotherapy for unresectable stage IIIA and IIIB NSCLC patients were consistent with other studies and showed no benefit to radiation doses above 66 Gy. Furthermore, maintaining low esophageal V60 and lung V5 were associated with lower morbidity and mortality.
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Affiliation(s)
- Mark E Bernard
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Scott M Glaser
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Beant S Gill
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - James D Luketich
- Department of Thoracic Surgery, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - David M Friedland
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Mark A Socinski
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
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Huang BT, Wu LL, Guo LJ, Xu LY, Huang RH, Lin PX, Chen JZ, Li DR, Chen CZ. Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer. Onco Targets Ther 2017; 10:2209-2217. [PMID: 28458564 PMCID: PMC5403125 DOI: 10.2147/ott.s132388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare the radiobiological response between simultaneously dose-escalated and non-escalated intensity-modulated radiation therapy (DE-IMRT and NE-IMRT) for patients with upper thoracic esophageal cancer (UTEC) using radiobiological evaluation. METHODS Computed tomography simulation data sets for 25 patients pathologically diagnosed with primary UTEC were used in this study. DE-IMRT plan with an escalated dose of 64.8 Gy/28 fractions to the gross tumor volume (GTV) and involved lymph nodes from 25 patients pathologically diagnosed with primary UTEC, was compared to an NE-IMRT plan of 50.4 Gy/28 fractions. Dose-volume metrics, tumor control probability (TCP), and normal tissue complication probability for the lung and spinal cord were compared. In addition, the risk of acute esophageal toxicity (AET) and late esophageal toxicity (LET) were also analyzed. RESULTS Compared with NE-IMRT plan, we found the DE-IMRT plan resulted in a 14.6 Gy dose escalation to the GTV. The tumor control was predicted to increase by 31.8%, 39.1%, and 40.9% for three independent TCP models. The predicted incidence of radiation pneumonitis was similar (3.9% versus 3.6%), and the estimated risk of radiation-induced spinal cord injury was extremely low (<0.13%) in both groups. Regarding the esophageal toxicities, the estimated grade ≥2 and grade ≥3 AET predicted by the Kwint model were increased by 2.5% and 3.8%. Grade ≥2 AET predicted using the Wijsman model was increased by 14.9%. The predicted incidence of LET was low (<0.51%) in both groups. CONCLUSION Radiobiological evaluation reveals that the DE-IMRT dosing strategy is feasible for patients with UTEC, with significant gains in tumor control and minor or clinically acceptable increases in radiation-induced toxicities.
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Affiliation(s)
- Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - Li-Li Wu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - Long-Jia Guo
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - Liang-Yu Xu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - Rui-Hong Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - Pei-Xian Lin
- Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
| | - Jian-Zhou Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - De-Rui Li
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - Chuang-Zhen Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou
- Correspondence: Chuang-Zhen Chen, Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong Province, 515031, People’s Republic of China, Tel/fax +86 754 8855 5844, Email
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Li X, Xu S, Cheng Y, Shu J. HSPB1 polymorphisms might be associated with radiation-induced damage risk in lung cancer patients treated with radiotherapy. Tumour Biol 2016; 37:5743-9. [PMID: 26874728 DOI: 10.1007/s13277-016-4959-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
Abstract
Several studies investigating the association between heat shock protein beta-1 (HSPB1) polymorphisms and radiation-induced damage in lung cancer patients administrated with radiotherapy have derived conflicting results. This meta-analysis aimed to assess the association between the HSPB1 genes' (rs2868370 and rs2868371) polymorphisms and the risk of radiation-induced damage in lung cancer patients. After an electronic literature search, four articles including six studies were found to be eligible for this meta-analysis. No association was observed between rs2868370 genotypes and radiation-induced damage risk. However, rs2868371 showed a statistically increased risk of radiation-induced damage under CC vs. CG/GG model (OR = 1.59, 95 % CI = 1.10-2.29). Subgroup analysis by ethnicity showed that the genotypes of rs2868371 were also associated with a significantly increased risk of radiation-induced damage in CC vs. CG/GG model (OR = 1.86, 95 % CI = 1.21-2.83) among mixed ethnicities which are mainly comprised of white people. When the data was stratified by organ-damaged, a significant association was only observed in the esophagus group (OR = 2.94, 95 % CI = 1.35-6.37, for CC vs. CG/GG model). In conclusion, the present study demonstrated that the rs2868371 genotypes of HSPB1 might be associated with radiation-induced esophagus damage risk, especially in Caucasians but not in the Asian population.
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Affiliation(s)
- Xiaofeng Li
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Geriatrics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Sheng Xu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Geriatrics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yu Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Geriatrics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Jun Shu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Geriatrics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Yu Y, Guan H, Dong Y, Xing L, Li X. Advances in dosimetry and biological predictors of radiation-induced esophagitis. Onco Targets Ther 2016; 9:597-603. [PMID: 26869804 PMCID: PMC4734814 DOI: 10.2147/ott.s97019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To summarize the research progress about the dosimetry and biological predictors of radiation-induced esophagitis. METHODS We performed a systematic literature review addressing radiation esophagitis in the treatment of lung cancer published between January 2009 and May 2015 in the PubMed full-text database index systems. RESULTS Twenty-eight eligible documents were included in the final analysis. Many clinical factors were related to the risk of radiation esophagitis, such as elder patients, concurrent chemoradiotherapy, and the intense radiotherapy regimen (hyperfractionated radiotherapy or stereotactic body radiotherapy). The parameters including Dmax, Dmean, V20, V30, V50, and V55 may be valuable in predicting the occurrence of radiation esophagitis in patients receiving concurrent chemoradiotherapy. Genetic variants in inflammation-related genes are also associated with radiation-induced toxicity. CONCLUSION Dosimetry and biological factors of radiation-induced esophagitis provide clinical information to decrease its occurrence and grade during radiotherapy. More prospective studies are warranted to confirm their prediction efficacy.
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Affiliation(s)
- Yang Yu
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Hui Guan
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Yuanli Dong
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong Province, People's Republic of China
| | - Xiaolin Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong Province, People's Republic of China
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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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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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Acute phase response before treatment predicts radiation esophagitis in non-small cell lung cancer. Radiother Oncol 2014; 110:493-8. [PMID: 24560756 DOI: 10.1016/j.radonc.2014.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE Radiation esophagitis (RE) represents an inflammatory reaction to radiation therapy (RT). We hypothesized that aspects of the physiologic acute phase response (APR) predicts RE. MATERIAL AND METHODS We retrospectively analyzed 285 patients with non-small cell lung cancer (NSCLC) treated with definitive radiation. The primary analysis was the association of pretreatment lab values reflective of the APR with symptomatic (grade ⩾ 2) RE. Univariate and multivariate odds ratios (ORs) were calculated to test associations of clinical and pretreatment lab values with RE. Optimal cutpoints and multivariable risk stratification groupings were determined via recursive partitioning analysis. RESULTS Pretreatment platelet counts were higher and hemoglobin levels lower in patients who developed RE (P<0.05). Based on these two pre-treatment risk factors, an APR score was defined as 0 (no risk factors), 1 (either risk factor), or 2 (both risk factors). APR score was significantly associated with RE in both univariate (OR = 2.3 for each point, 95% confidence interval [CI] 1.5-3.4, P = 0.001) and multivariate (OR = 2.1, 95% CI 1.3-3.4, P = 0.002) analyses. CONCLUSIONS The APR score may represent a novel metric to predict RE. However, pending validation in an independent dataset, caution is advised when interpreting these results given their retrospective and thus exploratory nature.
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Nicolini A, Ferrari P, Masoni MC, Fini M, Pagani S, Giampietro O, Carpi A. Malnutrition, anorexia and cachexia in cancer patients: A mini-review on pathogenesis and treatment. Biomed Pharmacother 2013; 67:807-17. [DOI: 10.1016/j.biopha.2013.08.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/10/2013] [Indexed: 12/17/2022] Open
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Etiz D, Bayman E, Akcay M, Sahin B, Bal C. Dosimetric and clinical predictors of acute esophagitis in lung cancer patients in Turkey treated with radiotherapy. Asian Pac J Cancer Prev 2013; 14:4223-8. [PMID: 23991980 DOI: 10.7314/apjcp.2013.14.7.4223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the clinical and dosimetric factors associated with acute esophagitis (AE) in lung cancer patients treated with conformal radiotherapy (RT) in Turkey. MATERIALS AND METHODS In this retrospective review 104 lung cancer patients were examined. Esophagitis grades were verified weekly during treatment, and at 1 week, and 1 and 2 months afterwards. The clinical parameters included patient age, gender, tumor pathology, number of chemotherapy treatments before RT, concurrent chemotherapy, radiation dose, tumor response to RT, tumor localization, interruption of RT, weight loss, tumor and nodal stage and tumor volume. The following dosimetric parameters were analyzed for correlation of AE: The maximum (Dmax) and mean (Dmean) doses delivered to the esophagus, the percentage of esophagus volume receiving ≥10 Gy (V10), ≥20 Gy (V20), ≥30 Gy (V30), ≥35 Gy (V35), ≥40 Gy (V40), ≥45 Gy (V45), ≥50 Gy (V50) and ≥60 Gy (V60). RESULTS Fifty-five patients (52.9%) developed AE. Maximum grades of AE were recorded: Grade 1 in 51 patients (49%), and Grade 2 in 4 patients (3.8%). Clinical factors had no statistically significant influence on the incidence of AE. In terms of dosimetric findings, correlation analyses demonstrated a significant association between AE and Dmax (>5117 cGy), Dmean (>1487 cGy) and V10-60 (percentage of volume receiving >10 to 60 Gy). The most significant relationship between RT and esophagitis were in Dmax (>5117 cGy) (p=0.002) and percentage of esophageal volume receiving >30 Gy (V30>31%) (p=0.008) in the logistic regression analysis. CONCLUSIONS The maximum dose esophagus greater than 5117 cGy and approximately one third (31%) of the esophageal volume receiving >30 Gy was the most statistically significant predictive factor associated with esophagitis due to RT.
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Affiliation(s)
- Durmus Etiz
- Department of Radiation Oncology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
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Uyterlinde W, Chen C, Kwint M, de Bois J, Vincent A, Sonke JJ, Belderbos J, van den Heuvel M. Prognostic parameters for acute esophagus toxicity in intensity modulated radiotherapy and concurrent chemotherapy for locally advanced non-small cell lung cancer. Radiother Oncol 2013; 107:392-7. [PMID: 23647749 DOI: 10.1016/j.radonc.2013.04.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to correlate clinical and dosimetric variables with acute esophageal toxicity (AET) following Intensity Modulated Radiotherapy (IMRT) with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC). In addition, timeline of AET was reported. MATERIAL AND METHODS 153 patients with locally advanced NSCLC treated with 66 Gy/2.75 Gy/24 fractions of radiotherapy and concurrent daily low dose cisplatin were selected. Medical records and treatments of these patients were retrospectively reviewed. Maximum AET grade ≥2 and maximum grade 3 were the endpoints of this study. Dates for onset, maximum and recovery (to baseline) of AET were reported. Univariate and multivariate analysis were applied to correlate clinical, tumor, dosimetric and chemotherapy dose variables to AET grade ≥2 and grade 3. RESULTS AET grade 2 occurred in 37% and grade 3 in 20% of the patients. The median onset of AET was around day 15 for all grades. The median onset of the maximum grade was day 30 for both grades 2 and 3. The median duration was 43 days for grade 1, 50 days for grade 2 and >80 days for grade 3. Of the grade 3 AET patients, 48% recovered within 3 months. Esophagus V50, ethnic background, and the number of cisplatin administrations were significantly correlated with grade 3 AET. CONCLUSIONS For NSCLC patients treated with concurrent chemotherapy and IMRT A higher number of cisplatin administrations, non-Caucasian background and higher V50oes were associated with grade 3 AET. The median onset of AET grade 3 is 15 days after the start of treatment, maximized at day 30, with a median duration of >80 days.
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Affiliation(s)
- Wilma Uyterlinde
- Department of Thoracic Oncology, NKI-AVL, Amsterdam, The Netherlands.
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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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Kwint M, Uyterlinde W, Nijkamp J, Chen C, de Bois J, Sonke JJ, van den Heuvel M, Knegjens J, van Herk M, Belderbos J. Acute Esophagus Toxicity in Lung Cancer Patients After Intensity Modulated Radiation Therapy and Concurrent Chemotherapy. Int J Radiat Oncol Biol Phys 2012; 84:e223-8. [DOI: 10.1016/j.ijrobp.2012.03.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 12/25/2022]
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Guerra JLL, Gomez D, Wei Q, Liu Z, Wang LE, Yuan X, Zhuang Y, Komaki R, Liao Z. Association between single nucleotide polymorphisms of the transforming growth factor β1 gene and the risk of severe radiation esophagitis in patients with lung cancer. Radiother Oncol 2012; 105:299-304. [PMID: 23022171 DOI: 10.1016/j.radonc.2012.08.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 08/21/2012] [Accepted: 08/26/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE We investigated the association between single nucleotide polymorphisms (SNPs) in the transforming growth factor β1 (TGFβ1) gene and the risk of radiation-induced esophageal toxicity (RE) in patients with non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS Ninety-seven NSCLC patients with available genomic DNA samples and mostly treated with intensity modulated radio(chemo)therapy from 2003 to 2006 were used as a test dataset and 101 NSCLC patients treated with 3-dimensional conformal radio(chemo)therapy from 1998 to 2002 were used as a validation set. We genotyped three SNPs of the TGFβ1 gene (rs1800469:C-509T, rs1800471:G915C, and rs1982073:T869C) by the polymerase chain reaction restriction fragment length polymorphism method. RESULTS In the test dataset, the CT/TT genotypes of TGFβ1 rs1800469:C-509T were associated with a statistically significant higher risk of RE grade⩾3 in univariate (P=0.026) and multivariate analysis (P=0.045) when compared with the CC genotype. These results were again observed in both univariate (P=0.045) and multivariate (P=0.023) analysis in the validation dataset. CONCLUSION We found and validated that the TGFβ1 rs1800469:C-509T genotype is associated with severe RE. This response marker may be used for guiding therapy intensity in an individual patient, which would further the goal of individualized therapy.
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Lopez Guerra JL, Wei Q, Yuan X, Gomez D, Liu Z, Zhuang Y, Yin M, Li M, Wang LE, Cox JD, Liao Z. Functional promoter rs2868371 variant of HSPB1 associates with radiation-induced esophageal toxicity in patients with non-small-cell lung cancer treated with radio(chemo)therapy. Radiother Oncol 2011; 101:271-7. [PMID: 21937138 DOI: 10.1016/j.radonc.2011.08.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 01/09/2023]
Abstract
PURPOSE We investigated the association between single-nucleotide polymorphisms (SNPs) in the heat shock protein beta-1 (HSPB1) gene and the risk of radiation-induced esophageal toxicity (RIET) in patients with non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS The experimental dataset comprised 120 NSCLC patients who were treated with radio(chemo)therapy between 2005 and 2009, when novel radiation techniques were implemented at MD Anderson. The validation dataset comprised 181 NSCLC patients treated between 1998 and 2004. We genotyped two SNPs of the HSPB1 gene (rs2868370 and rs2868371) by TaqMan assay. RESULTS Univariate and multivariate analyses of the experimental dataset showed that the CG/GG genotypes of HSPB1 rs2868371 were associated with significantly lower risk of grade ⩾3 RIET than the CC genotype (univariate hazard ratio [HR] 0.30; 95% confidence interval [CI], 0.10-0.91; P=0.033; multivariate HR 0.29; 95% CI, 0.09-0.97; P=0.045). This difference in risk was replicated in the validation cohort despite the different radiation techniques used during that period. CONCLUSIONS The CG/GG genotypes of HSPB1 rs2868371 were associated with lower risk of RIET, compared with the CC genotype in patients with NSCLC treated with radio(chemo)therapy. This finding should be validated in large multi-institutional prospective trials.
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Affiliation(s)
- Jose Luis Lopez Guerra
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, USA
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Overgaard J. Advancing radiation oncology through scientific publication – 100 volumes of Radiotherapy and Oncology. Radiother Oncol 2011; 100:1-6. [DOI: 10.1016/j.radonc.2011.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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