Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy

Chun Chen; Wilma Uyterlinde; Jan-Jakob Sonke; Josien de Bois; Michel van den Heuvel; José Belderbos

doi:10.1016/j.radonc.2013.08.017

Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy

Chun Chen
, Wilma Uyterlinde
, Jan-Jakob Sonke
, Josien de Bois
, Michel van den Heuvel
, José Belderbos

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND AND PURPOSE: We reported the incidence of severe late esophagus toxicity (LET) in locally advanced NSCLC patients treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. Acute esophagus toxicity (AET) and the dose to the esophagus were analyzed for their associations with severe LET.

MATERIAL AND METHODS: Two hundred and thirty-one patients treated from 2008 to 2011 with hypofractionated IMRT (66Gy/24fx) and concurrent daily low dose cisplatin were included. The association between AET and severe LET (grade ≥ 3 RTOG/EORTC) was tested through Cox-proportional-hazards model. Equivalent uniform dose (EUD) to the esophagus and the volume percentage receiving more than x Gy (Vx) were applied by Lyman-Kutcher-Burman (LKB) model.

RESULTS: A total of 171 patients were eligible for this study. Severe LET was observed in 6% patients. Both the maximum grade and the recovery rate of AET were significantly associated with severe LET. In the EUDn-LKB model, the fitted values and 95% confidence intervals (CIs) were TD50=76.1 Gy (73.2-78.6), m=0.03 (0.02-0.06) and n=0.03 (0-0.08). In the Vx-LKB model, the fitted values and 95% CIs were Tx50=23.5% (16.4-46.6), m=0.44 (0.32-0.60) and x=76.7 Gy (74.7-77.5).

CONCLUSIONS: Severe AET, EUD (n=0.03) and V76.7 to the esophagus were significantly associated with severe LET. An independent validation study is required.

Original language	English
Pages (from-to)	337-41
Number of pages	5
Journal	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume	108
Issue number	2
DOIs	https://doi.org/10.1016/j.radonc.2013.08.017
Publication status	Published - Aug 2013
Externally published	Yes

Keywords

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/mortality
Chemoradiotherapy/adverse effects
Cisplatin/adverse effects
Cohort Studies
Esophagus/drug effects
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Lung Neoplasms/mortality
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness/pathology
Neoplasm Staging
Netherlands
Radiation Injuries/diagnosis
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated/adverse effects
Retrospective Studies
Risk Assessment
Survival Analysis
Time Factors

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10.1016/j.radonc.2013.08.017

Cite this

@article{4d2ea7da9a2748fca7a40101320aaed8,

title = "Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy",

abstract = "BACKGROUND AND PURPOSE: We reported the incidence of severe late esophagus toxicity (LET) in locally advanced NSCLC patients treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. Acute esophagus toxicity (AET) and the dose to the esophagus were analyzed for their associations with severe LET.MATERIAL AND METHODS: Two hundred and thirty-one patients treated from 2008 to 2011 with hypofractionated IMRT (66Gy/24fx) and concurrent daily low dose cisplatin were included. The association between AET and severe LET (grade ≥ 3 RTOG/EORTC) was tested through Cox-proportional-hazards model. Equivalent uniform dose (EUD) to the esophagus and the volume percentage receiving more than x Gy (Vx) were applied by Lyman-Kutcher-Burman (LKB) model.RESULTS: A total of 171 patients were eligible for this study. Severe LET was observed in 6\% patients. Both the maximum grade and the recovery rate of AET were significantly associated with severe LET. In the EUDn-LKB model, the fitted values and 95\% confidence intervals (CIs) were TD50=76.1 Gy (73.2-78.6), m=0.03 (0.02-0.06) and n=0.03 (0-0.08). In the Vx-LKB model, the fitted values and 95\% CIs were Tx50=23.5\% (16.4-46.6), m=0.44 (0.32-0.60) and x=76.7 Gy (74.7-77.5).CONCLUSIONS: Severe AET, EUD (n=0.03) and V76.7 to the esophagus were significantly associated with severe LET. An independent validation study is required.",

keywords = "Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung/mortality, Chemoradiotherapy/adverse effects, Cisplatin/adverse effects, Cohort Studies, Esophagus/drug effects, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Lung Neoplasms/mortality, Male, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness/pathology, Neoplasm Staging, Netherlands, Radiation Injuries/diagnosis, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated/adverse effects, Retrospective Studies, Risk Assessment, Survival Analysis, Time Factors",

author = "Chun Chen and Wilma Uyterlinde and Jan-Jakob Sonke and \{de Bois\}, Josien and \{van den Heuvel\}, Michel and Jos{\'e} Belderbos",

year = "2013",

month = aug,

doi = "10.1016/j.radonc.2013.08.017",

language = "English",

volume = "108",

pages = "337--41",

journal = "Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy. / Chen, Chun; Uyterlinde, Wilma; Sonke, Jan-Jakob et al.
In: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Vol. 108, No. 2, 08.2013, p. 337-41.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy

AU - Chen, Chun

AU - Uyterlinde, Wilma

AU - Sonke, Jan-Jakob

AU - de Bois, Josien

AU - van den Heuvel, Michel

AU - Belderbos, José

PY - 2013/8

Y1 - 2013/8

N2 - BACKGROUND AND PURPOSE: We reported the incidence of severe late esophagus toxicity (LET) in locally advanced NSCLC patients treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. Acute esophagus toxicity (AET) and the dose to the esophagus were analyzed for their associations with severe LET.MATERIAL AND METHODS: Two hundred and thirty-one patients treated from 2008 to 2011 with hypofractionated IMRT (66Gy/24fx) and concurrent daily low dose cisplatin were included. The association between AET and severe LET (grade ≥ 3 RTOG/EORTC) was tested through Cox-proportional-hazards model. Equivalent uniform dose (EUD) to the esophagus and the volume percentage receiving more than x Gy (Vx) were applied by Lyman-Kutcher-Burman (LKB) model.RESULTS: A total of 171 patients were eligible for this study. Severe LET was observed in 6% patients. Both the maximum grade and the recovery rate of AET were significantly associated with severe LET. In the EUDn-LKB model, the fitted values and 95% confidence intervals (CIs) were TD50=76.1 Gy (73.2-78.6), m=0.03 (0.02-0.06) and n=0.03 (0-0.08). In the Vx-LKB model, the fitted values and 95% CIs were Tx50=23.5% (16.4-46.6), m=0.44 (0.32-0.60) and x=76.7 Gy (74.7-77.5).CONCLUSIONS: Severe AET, EUD (n=0.03) and V76.7 to the esophagus were significantly associated with severe LET. An independent validation study is required.

AB - BACKGROUND AND PURPOSE: We reported the incidence of severe late esophagus toxicity (LET) in locally advanced NSCLC patients treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. Acute esophagus toxicity (AET) and the dose to the esophagus were analyzed for their associations with severe LET.MATERIAL AND METHODS: Two hundred and thirty-one patients treated from 2008 to 2011 with hypofractionated IMRT (66Gy/24fx) and concurrent daily low dose cisplatin were included. The association between AET and severe LET (grade ≥ 3 RTOG/EORTC) was tested through Cox-proportional-hazards model. Equivalent uniform dose (EUD) to the esophagus and the volume percentage receiving more than x Gy (Vx) were applied by Lyman-Kutcher-Burman (LKB) model.RESULTS: A total of 171 patients were eligible for this study. Severe LET was observed in 6% patients. Both the maximum grade and the recovery rate of AET were significantly associated with severe LET. In the EUDn-LKB model, the fitted values and 95% confidence intervals (CIs) were TD50=76.1 Gy (73.2-78.6), m=0.03 (0.02-0.06) and n=0.03 (0-0.08). In the Vx-LKB model, the fitted values and 95% CIs were Tx50=23.5% (16.4-46.6), m=0.44 (0.32-0.60) and x=76.7 Gy (74.7-77.5).CONCLUSIONS: Severe AET, EUD (n=0.03) and V76.7 to the esophagus were significantly associated with severe LET. An independent validation study is required.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Non-Small-Cell Lung/mortality

KW - Chemoradiotherapy/adverse effects

KW - Cisplatin/adverse effects

KW - Cohort Studies

KW - Esophagus/drug effects

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Kaplan-Meier Estimate

KW - Lung Neoplasms/mortality

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm Invasiveness/pathology

KW - Neoplasm Staging

KW - Netherlands

KW - Radiation Injuries/diagnosis

KW - Radiotherapy Dosage

KW - Radiotherapy, Intensity-Modulated/adverse effects

KW - Retrospective Studies

KW - Risk Assessment

KW - Survival Analysis

KW - Time Factors

U2 - 10.1016/j.radonc.2013.08.017

DO - 10.1016/j.radonc.2013.08.017

M3 - Article

C2 - 24074814

SN - 0167-8140

VL - 108

SP - 337

EP - 341

JO - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

JF - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

IS - 2

ER -

Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy

Abstract

Keywords

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