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Ji MC, Li ZJ, Li K, Wang YX, Yang B, Lv LL, Su Y, Zhang ZW, Huo ZC, Qi Q, Lu YC, Cui ZQ, Liu YB. Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation. World J Clin Cases 2024; 12:2995-3003. [PMID: 38898857 PMCID: PMC11185373 DOI: 10.12998/wjcc.v12.i17.2995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Radiation esophagitis (RE) is one of the most common clinical symptoms of regi-onal lymph node radiotherapy for breast cancer. However, there are fewer studies focusing on RE caused by hypofractionated radiotherapy (HFRT). AIM To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes. METHODS Between January and December 2022, we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F. RESULTS Of the 64 patients in this study, 24 (37.5%) did not develop RE, 29 (45.3%) developed grade 1 RE (G1RE), 11 (17.2%) developed grade 2 RE (G2RE), and none developed grade 3 RE or higher. Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose, mean dose, relative volume 20-40, and absolute volume (AV) 20-40. Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE (P < 0.001). The optimal threshold for AV30 was 2.39 mL [area under the curve (AUC): 0.996; sensitivity: 90.9%; specificity: 91.1%]. The optimal threshold for AV35 was 0.71 mL (AUC: 0.932; sensitivity: 90.9%; specificity: 83.9%). CONCLUSION AV30 and AV35 were significantly associated with G2RE. The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL, respectively.
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Affiliation(s)
- Mei-Chen Ji
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Zhi-Jia Li
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Ke Li
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Yun-Xiao Wang
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Bo Yang
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Lin-Lin Lv
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Ying Su
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Zhi-Wei Zhang
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Zhong-Chao Huo
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Qing Qi
- Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
| | - Yong-Chang Lu
- General Surgery Department, Handan First Hospital, Handan 056002, Hebei Province, China
| | - Zhi-Qiang Cui
- Department of Breast Surgery, The Affiliated Hospital of Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Yan-Bao Liu
- School of Clinical Medicine, Hebei University of Engineering, Handan 056002, Hebei Province, China
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Sharmin S, Sultana R, Mollah NU, Rasheed MO, Anika AS, Rassell M. Association of Radiation-Induced Acute Esophagitis With Dosimetric Parameters of Oesophagus in Breast Carcinoma Patients Receiving Supraclavicular Nodal Irradiation. Cureus 2024; 16:e60778. [PMID: 38903289 PMCID: PMC11188969 DOI: 10.7759/cureus.60778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION We conducted this investigation to ascertain the dosimetric properties such as the mean and maximum radiation dosage during radiotherapy as well as the extent of radiation exposure to the esophagus. These factors can potentially impact the development of esophagitis in breast cancer patients undergoing supraclavicular radiation. METHODOLOGY From January to June 2023, an observational study was conducted at Bangabandhu Sheikh Mujib Medical University in Bangladesh. The patients received radiation therapy (40.05 Gy in 15 parts) to the chest wall and supraclavicular node for three weeks. We were able to guess the following from the dose volume histogram (DVH) data: the length of the esophagus in the treatment area (i.e., the size of the esophagus that was visible on the planning CT scan), the maximum dose (Dmax), the mean dose (Dmean), and the volume of the 10Gy (V10Gy) and 20Gy (V20Gy) doses that were given to the esophagus. During radiotherapy, patients were checked on once a week, and the radiotherapy oncology group was used to evaluate and grade esophagitis Results: Patients with left-sided breast cancer showed a higher Dmean, Dmax, and length of the esophagus compared to those with right-sided breast cancer. Specifically, the Dmean was 6.7 (±2.1) Gy, the Dmax was 39.2 (±1.5) Gy, and the length of the esophagus was 6.1 (±1.2) Gy. Patients with left breast cancer had elevated V10Gy and V20Gy values for the esophagus, but the difference was not statistically significant. The incidence of V10Gy for right-sided breast cancer and left-sided breast cancer was 4.2% (±2.6%) and 19.8% (±9.2%), respectively. The V20Gy was 2.4% (±0.9%) for right-sided breast cancer and 13.09% (±5.0%) for left-sided breast cancer Conclusion: In conclusion, there is a strong association between the mean oesophageal dose and radiation to the left supraclavicular region following surgery in women with breast cancer and acute esophagitis. We can reduce esophageal toxicity by prescribing dose restrictions and performing precise delineation of the esophagus.
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Affiliation(s)
- Sadia Sharmin
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Rokaya Sultana
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Nazir Uddin Mollah
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Mamun O Rasheed
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Afsana Sharmin Anika
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Md Rassell
- Department of Surgical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
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Caissie A, Mierzwa M, Fuller CD, Rajaraman M, Lin A, MacDonald A, Popple R, Xiao Y, VanDijk L, Balter P, Fong H, Xu H, Kovoor M, Lee J, Rao A, Martel M, Thompson R, Merz B, Yao J, Mayo C. Head and Neck Radiation Therapy Patterns of Practice Variability Identified as a Challenge to Real-World Big Data: Results From the Learning from Analysis of Multicentre Big Data Aggregation (LAMBDA) Consortium. Adv Radiat Oncol 2023; 8:100925. [PMID: 36711064 PMCID: PMC9873496 DOI: 10.1016/j.adro.2022.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/24/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose Outside of randomized clinical trials, it is difficult to develop clinically relevant evidence-based recommendations for radiation therapy (RT) practice guidelines owing to lack of comprehensive real-world data. To address this knowledge gap, we formed the Learning from Analysis of Multicenter Big Data Aggregation consortium to cooperatively implement RT data standardization, develop software solutions for data analysis, and recommend clinical practice change based on real-world data analyzed. The first phase of this "Big Data" study aimed at characterizing variability in clinical practice patterns of dosimetric data for organs at risk (OARs) that would undermine subsequent use of large-scale, electronically aggregated data to characterize associations with outcomes. Evidence from this study was used as the basis for practical recommendations to improve data quality. Methods and Materials Dosimetric details of patients with head and neck cancer treated with radiation therapy between 2014 and 2019 were analyzed. Institutional patterns of practice were characterized, including structure nomenclature, volumes, and frequency of contouring. Dose volume histogram (DVH) distributions were characterized and compared with institutional constraints and literature values. Results Plans for 4664 patients treated to a mean plan dose of 64.4 ± 13.2 Gy in 32 ± 4 fractions were aggregated. Before implementation of TG-263 guidelines in each institution, there was variability in OAR nomenclature across institutions and structures. With evidence from this study, we identified a targeted and practical set of recommendations aimed at improving the quality of real-world data. Conclusions Quantifying similarities and differences among institutions for OAR structures and DVH metrics is the launching point for next steps to investigate potential relationships between DVH parameters and patient outcomes.
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Affiliation(s)
| | | | | | | | - Alex Lin
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Helen Fong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heping Xu
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Arvind Rao
- University of Michigan, Ann Arbor, Michigan
| | | | - Reid Thompson
- University of Oregon Health Sciences Center, Portland, Oregon
| | - Brandon Merz
- University of Oregon Health Sciences Center, Portland, Oregon
| | - John Yao
- University of Michigan, Ann Arbor, Michigan
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Qiu J, Ke D, Lin H, Yu Y, Zheng Q, Li H, Zheng H, Liu L, Li J. Using inflammatory indexes and clinical parameters to predict radiation esophagitis in patients with small-cell lung cancer undergoing chemoradiotherapy. Front Oncol 2022; 12:898653. [PMID: 36483030 PMCID: PMC9722947 DOI: 10.3389/fonc.2022.898653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE Radiation esophagitis (RE) is a common adverse effect in small cell lung cancer (SCLC) patients undergoing thoracic radiotherapy. We aim to develop a novel nomogram to predict the acute severe RE (grade≥2) receiving chemoradiation in SCLC patients. MATERIALS AND METHODS the risk factors were analyzed by logistic regression, and a nomogram was constructed based on multivariate analysis results. The clinical value of the model was evaluated using the area under the receiver operating curve (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA). The correlations of inflammation indexes were assessed using Spearman correlation analysis. RESULTS Eighty-four of 187 patients (44.9%) developed grade ≥2 RE. Univariate analysis indicated that concurrent chemoradiotherapy (CCRT, p < 0.001), chemotherapy cycle (p = 0.097), system inflammation response index (SIRI, p = 0.048), prognostic-nutrition index (PNI, p = 0.073), platelets-lymphocyte radio (PLR, p = 0.026), platelets-albumin ratio (PAR, p = 0.029) were potential predictors of RE. In multivariate analysis, CCRT [p < 0.001; OR, 3.380; 95% CI, 1.767-6.465], SIRI (p = 0.047; OR, 0.436; 95% CI, 0.192-0.989), and PAR (p = 0.036; OR, 2.907; 95% CI, 1.071-7.891) were independent predictors of grade ≥2 RE. The AUC of nomogram was 0.702 (95% CI, 0.626-0.778), which was greater than each independent predictor (CCRT: 0.645; SIRI: 0.558; PAR: 0.559). Calibration curves showed high coherence between the predicted and actual observation RE, and DCA displayed satisfactory clinical utility. CONCLUSION In this study, CCRT, SIRI, and PAR were independent predictors for RE (grade ≥2) in patients with SCLC receiving chemoradiotherapy. We developed and validated a predictive model through these factors. The developed nomogram with superior prediction ability can be used as a quantitative model to predict RE.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiancheng Li
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Radiation-Induced Esophagitis in Non-Small-Cell Lung Cancer Patients: Voxel-Based Analysis and NTCP Modeling. Cancers (Basel) 2022; 14:cancers14071833. [PMID: 35406605 PMCID: PMC8997452 DOI: 10.3390/cancers14071833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Radiation-induced esophagitis (RE) is a common dose-limiting complication associated with concurrent chemoradiation therapy for Non-Small-Cell Lung Cancer (NSCLC), and a wide range of esophageal dosimetric parameters have been described as predictive of RE. In this study, we characterize the risk of RE for NSCLC patients enrolled in a prospective trial comparing intensity-modulated RT versus passive scattering proton therapy for locally advanced NSCLC. Dose patterns associated with RE were analyzed by applying voxel-based analysis approaches, and predictive models for RE were finally investigated. Two predictive models for acute RE with good cross-validated predictive performances and discrimination capability were developed (thoracic esophageal model: ROC-AUC = 0.73; whole esophagus model: ROC-AUC = 0.70). Abstract The aim of our study is to characterize the risk of radiation-induced esophagitis (RE) in a cohort of Non-Small-Cell Lung Cancer (NSCLC) patients treated with concurrent chemotherapy and photon/proton therapy. For each patient, the RE was graded according to the CTCAE v.3. The esophageal dose-volume histograms (DVHs) were extracted. Voxel-based analyses (VBAs) were performed to assess the spatial patterns of the dose differences between patients with and without RE of grade ≥ 2. Two hierarchical NTCP models were developed by multivariable stepwise logistic regression based on non-dosimetric factors and on the DVH metrics for the whole esophagus and its anatomical subsites identified by the VBA. In the 173 analyzed patients, 76 (44%) developed RE of grade ≥ 2 at a median follow-up time of 31 days. The VBA identified regions of significant association between dose and RE in a region encompassing the thoracic esophagus. We developed two NTCP models, including the RT modality and a dosimetric factor: V55Gy for the model related to the whole esophagus, and the mean dose for the model designed on the thoracic esophagus. The cross-validated performance showed good predictions for both models (ROC-AUC of 0.70 and 0.73, respectively). The only slight improvement provided by the analysis of the thoracic esophageal subsites might be due to the relevant sparing of cervical and lower thoracic esophagus in the analyzed cohort. Further studies on larger cohorts and a more heterogeneous set of dose distributions are needed to validate these preliminary findings and shed further light on the spatial patterns of RE development.
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Imano N, Nishibuchi I, Kawabata E, Kinugasa Y, Shi L, Sakai C, Ishida M, Sakane H, Akita T, Ishida T, Kimura T, Murakami Y, Tanaka K, Horikoshi Y, Sun J, Nagata Y, Tashiro S. Evaluating Individual Radiosensitivity for the Prediction of Acute Toxicities of Chemoradiotherapy in Esophageal Cancer Patients. Radiat Res 2021; 195:244-252. [PMID: 33400798 DOI: 10.1667/rade-20-00234.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
In this work, individual radiosensitivity was evaluated using DNA damage response and chromosomal aberrations (CAs) in peripheral blood lymphocytes (PBLs) for the prediction of acute toxicities of chemoradiotherapy (CRT) in esophageal cancer patients. Eighteen patients with esophageal cancer were enrolled in this prospective study. Prescribed doses were 60 Gy in 11 patients and 50 Gy in seven patients. Patients received 2 Gy radiotherapy five days a week. PBLs were obtained during treatment just before and 15 min after 2 Gy radiation therapy on the days when the cumulative dose reached 2, 20, 40 Gy and 50 or 60 Gy. PBLs were also obtained four weeks and six months after radiotherapy in all and 13 patients, respectively. Dicentric and ring chromosomes in PBLs were counted to evaluate the number of CAs. Gamma-H2AX foci per cell were scored to assess DNA double-strand breaks. We analyzed the association between these factors and adverse events. The number of γ-H2AX foci before radiotherapy showed no significant increase during CRT, while their increment was significantly reduced with the accumulation of radiation dose. The mean number of CAs increased during CRT up to 1.04 per metaphase, and gradually decreased to approximately 60% six months after CRT. Five patients showed grade 3 toxicities during or after CRT (overreactors: OR), while 13 had grade 2 or less toxicities (non-overreactors: NOR). The number of CAs was significantly higher in the OR group than in the NOR group at a cumulative dose of 20 Gy (mean value: 0.63 vs. 0.34, P = 0.02), 40 Gy (mean value: 0.90 vs. 0.52, P = 0.04), and the final day of radiotherapy (mean value: 1.49 vs. 0.84, P = 0.005). These findings suggest that number of CAs could be an index for predicting acute toxicities of CRT for esophageal cancer.
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Affiliation(s)
- Nobuki Imano
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Emi Kawabata
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasuha Kinugasa
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Lin Shi
- Institute of Medical Imaging and Digital Medicine, School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Chiemi Sakai
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mari Ishida
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Sakane
- Department of Diagnostic Radiology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kimio Tanaka
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasunori Horikoshi
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Jiying Sun
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Tashiro
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Aguado-Barrera ME, Martínez-Calvo L, Fernández-Tajes J, Calvo-Crespo P, Taboada-Valladares B, Lobato-Busto R, Gómez-Caamaño A, Vega A. Validation of Polymorphisms Associated with the Risk of Radiation-Induced Oesophagitis in an Independent Cohort of Non-Small-Cell Lung Cancer Patients. Cancers (Basel) 2021; 13:cancers13061447. [PMID: 33810047 PMCID: PMC8004670 DOI: 10.3390/cancers13061447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Genetic variants identified in association with radiation therapy side effects in non-small-cell lung cancer patients require an independent validation. Therefore, the aim of our study was to replicate, in an independent cohort, the analyses of previously published studies associating single-nucleotide polymorphisms with radiation-induced oesophagitis. Following the original models, 2 of the 18 variants associated with radiation-induced oesophagitis in non-small-cell lung cancer patients were confirmed. Furthermore, we meta-analysed our cohort together with those of the reference studies. Twelve variants located in genes of inflammation and DNA double-strand break repair pathways remained associated with oesophagitis. These variants could be included in models for clinical prediction of radiation-induced oesophagitis to evaluate their performance. Abstract Several studies have identified single-nucleotide polymorphisms (SNPs) associated with adverse effects in non-small-cell lung cancer (NSCLC) patients treated with radiation therapy. Here, using an independent cohort, we aimed to validate the reported associations. We selected 23 SNPs in 17 genes previously associated with radiation-induced oesophagitis for validation in a cohort of 178 Spanish NSCLC patients. Of them, 18 SNPs were finally analysed, following the methods described in the original published studies. Two SNPs replicated their association with radiation-induced oesophagitis (rs7165790 located in the BLM gene: odds ratio (OR) = 0.16, 95% CI = 0.04–0.65, p-value = 0.010; rs4772468 at FGF14: OR = 4.36, 95% CI = 1.15–16.46, p-value = 0.029). The SNP rs2868371 at HSPB1 was also validated but displayed an opposite effect to the formerly described (OR = 3.72; 95% CI = 1.49–9.25; p-value = 0.004). Additionally, we tested a meta-analytic approach including our results and the previous datasets reported in the referenced publications. Twelve SNPs (including the two previously validated) retained their statistically significant association with radiation-induced oesophagitis. This study strengthens the role of inflammation and DNA double-strand break repair pathways in the risk prediction of developing radiation-induced oesophagitis in NSCLC patients. The validated variants are good candidates to be evaluated in risk prediction models for patient stratification based on their radiation susceptibility.
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Affiliation(s)
- Miguel E. Aguado-Barrera
- Grupo Genética en Cáncer y Enfermedades Raras, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Fundación Pública Galega de Medicina Xenómica (FPGMX), 15706 Santiago de Compostela, A Coruña, Spain; (M.E.A.-B.); (L.M.-C.); (J.F.-T.)
| | - Laura Martínez-Calvo
- Grupo Genética en Cáncer y Enfermedades Raras, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Fundación Pública Galega de Medicina Xenómica (FPGMX), 15706 Santiago de Compostela, A Coruña, Spain; (M.E.A.-B.); (L.M.-C.); (J.F.-T.)
| | - Juan Fernández-Tajes
- Grupo Genética en Cáncer y Enfermedades Raras, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Fundación Pública Galega de Medicina Xenómica (FPGMX), 15706 Santiago de Compostela, A Coruña, Spain; (M.E.A.-B.); (L.M.-C.); (J.F.-T.)
| | - Patricia Calvo-Crespo
- Department of Radiation Oncology Hospital Clínico Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Grupo Genética en Cáncer y Enfermedades Raras, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, A Coruña, Spain; (P.C.-C.); (B.T.-V.)
| | - Begoña Taboada-Valladares
- Department of Radiation Oncology Hospital Clínico Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Grupo Genética en Cáncer y Enfermedades Raras, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, A Coruña, Spain; (P.C.-C.); (B.T.-V.)
| | - Ramón Lobato-Busto
- Department of Medical Physics Hospital Clínico Universitario de Santiago de Compostela Servizo Galego de Saúde (SERGAS), 15706 Santiago de Compostela, A Coruña, Spain;
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), 15706 Santiago de Compostela, A Coruña, Spain;
| | - Ana Vega
- Grupo Genética en Cáncer y Enfermedades Raras, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Fundación Pública Galega de Medicina Xenómica (FPGMX), Biomedical Network on Rare Diseases (CIBERER), 15706 Santiago de Compostela, A Coruña, Spain
- Correspondence: ; Tel.: +34-981-95-51-94
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