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Title: Predictors of High-grade Esophagitis After Definitive Three-dimensional Conformal Therapy, Intensity-modulated Radiation Therapy, or Proton Beam Therapy for Non-small cell Lung Cancer

Abstract

Introduction: We analyzed the ability of various patient- and treatment-related factors to predict radiation-induced esophagitis (RE) in patients with non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or proton beam therapy (PBT). Methods and Materials: Patients were treated for NSCLC with 3D-CRT, IMRT, or PBT at MD Anderson from 2000 to 2008 and had full dose-volume histogram (DVH) data available. The endpoint was severe (grade {>=}3) RE. The Lyman-Kutcher-Burman (LKB) model was used to analyze RE as a function of the fractional esophageal DVH, with clinical variables included as dose-modifying factors. Results: Overall, 652 patients were included: 405 patients were treated with 3D-CRT, 139 with IMRT, and 108 with PBT; corresponding rates of grade {>=}3 RE were 8%, 28%, and 6%, respectively, with a median time to onset of 42 days (range, 11-93 days). A fit of the fractional DVH LKB model demonstrated that the fractional effective dose was significantly different (P=.046) than 1 (fractional mean dose) indicating that high doses to small volumes are more predictive than mean esophageal dose. The model fit was better for 3D-CRT and PBT than for IMRT. Including receipt of concurrent chemotherapy as a dose-modifying factormore » significantly improved the LKB model (P=.005), and the model was further improved by including a variable representing treatment with >30 fractions. Examining individual types of chemotherapy agents revealed a trend toward receipt of concurrent taxanes and increased risk of RE (P=.105). Conclusions: Fractional dose (dose rate) and number of fractions (total dose) distinctly affect the risk of severe RE, estimated using the LKB model, and concurrent chemotherapy improves the model fit. This risk of severe RE is underestimated by this model in patients receiving IMRT.« less

Authors:
 [1];  [2]; ; ;  [3];  [1];  [4]; ; ; ;  [1]
  1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  3. Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  4. (Spain)
Publication Date:
OSTI Identifier:
22149645
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; DOSE RATES; ESOPHAGUS; HEALTH HAZARDS; LUNGS; NEOPLASMS; PATIENTS; PROTON BEAMS; RADIATION DOSES; RADIOTHERAPY; SIMULATION

Citation Formats

Gomez, Daniel R., E-mail: dgomez@mdanderson.org, Tucker, Susan L., Martel, Mary K., Mohan, Radhe, Balter, Peter A., Lopez Guerra, Jose Luis, Department of Radiation Oncology, Hospitales Universitarios Virgen del Rocio, Seville, Liu Hongmei, Komaki, Ritsuko, Cox, James D., and Liao Zhongxing. Predictors of High-grade Esophagitis After Definitive Three-dimensional Conformal Therapy, Intensity-modulated Radiation Therapy, or Proton Beam Therapy for Non-small cell Lung Cancer. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.071.
Gomez, Daniel R., E-mail: dgomez@mdanderson.org, Tucker, Susan L., Martel, Mary K., Mohan, Radhe, Balter, Peter A., Lopez Guerra, Jose Luis, Department of Radiation Oncology, Hospitales Universitarios Virgen del Rocio, Seville, Liu Hongmei, Komaki, Ritsuko, Cox, James D., & Liao Zhongxing. Predictors of High-grade Esophagitis After Definitive Three-dimensional Conformal Therapy, Intensity-modulated Radiation Therapy, or Proton Beam Therapy for Non-small cell Lung Cancer. United States. doi:10.1016/J.IJROBP.2012.01.071.
Gomez, Daniel R., E-mail: dgomez@mdanderson.org, Tucker, Susan L., Martel, Mary K., Mohan, Radhe, Balter, Peter A., Lopez Guerra, Jose Luis, Department of Radiation Oncology, Hospitales Universitarios Virgen del Rocio, Seville, Liu Hongmei, Komaki, Ritsuko, Cox, James D., and Liao Zhongxing. Thu . "Predictors of High-grade Esophagitis After Definitive Three-dimensional Conformal Therapy, Intensity-modulated Radiation Therapy, or Proton Beam Therapy for Non-small cell Lung Cancer". United States. doi:10.1016/J.IJROBP.2012.01.071.
@article{osti_22149645,
title = {Predictors of High-grade Esophagitis After Definitive Three-dimensional Conformal Therapy, Intensity-modulated Radiation Therapy, or Proton Beam Therapy for Non-small cell Lung Cancer},
author = {Gomez, Daniel R., E-mail: dgomez@mdanderson.org and Tucker, Susan L. and Martel, Mary K. and Mohan, Radhe and Balter, Peter A. and Lopez Guerra, Jose Luis and Department of Radiation Oncology, Hospitales Universitarios Virgen del Rocio, Seville and Liu Hongmei and Komaki, Ritsuko and Cox, James D. and Liao Zhongxing},
abstractNote = {Introduction: We analyzed the ability of various patient- and treatment-related factors to predict radiation-induced esophagitis (RE) in patients with non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or proton beam therapy (PBT). Methods and Materials: Patients were treated for NSCLC with 3D-CRT, IMRT, or PBT at MD Anderson from 2000 to 2008 and had full dose-volume histogram (DVH) data available. The endpoint was severe (grade {>=}3) RE. The Lyman-Kutcher-Burman (LKB) model was used to analyze RE as a function of the fractional esophageal DVH, with clinical variables included as dose-modifying factors. Results: Overall, 652 patients were included: 405 patients were treated with 3D-CRT, 139 with IMRT, and 108 with PBT; corresponding rates of grade {>=}3 RE were 8%, 28%, and 6%, respectively, with a median time to onset of 42 days (range, 11-93 days). A fit of the fractional DVH LKB model demonstrated that the fractional effective dose was significantly different (P=.046) than 1 (fractional mean dose) indicating that high doses to small volumes are more predictive than mean esophageal dose. The model fit was better for 3D-CRT and PBT than for IMRT. Including receipt of concurrent chemotherapy as a dose-modifying factor significantly improved the LKB model (P=.005), and the model was further improved by including a variable representing treatment with >30 fractions. Examining individual types of chemotherapy agents revealed a trend toward receipt of concurrent taxanes and increased risk of RE (P=.105). Conclusions: Fractional dose (dose rate) and number of fractions (total dose) distinctly affect the risk of severe RE, estimated using the LKB model, and concurrent chemotherapy improves the model fit. This risk of severe RE is underestimated by this model in patients receiving IMRT.},
doi = {10.1016/J.IJROBP.2012.01.071},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}