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Dose-volumetric parameters and prediction of severe acute esophagitis in patients with locally-advanced non small-cell lung cancer treated with neoadjuvant concurrent hyperfractionated-accelerated chemoradiotherapy

Farkhad Manapov1*, Susanna Sepe1, Maximilian Niyazi1, Claus Belka1, Godehard Friedel2 and Wilfried Budach3

Author Affiliations

1 Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München, München, Germany

2 Klinik für Thoraxchirurgie; Robert-Bosch-Hospital, Klinik Schillerhöhe, Stuttgart-Gerlingen, Germany

3 Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany

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Radiation Oncology 2013, 8:122  doi:10.1186/1748-717X-8-122

Published: 17 May 2013

Abstract

Background

To identify dose-volume parameters predictive for severity of acute esophagitis (CTC > grade 2) in locally-advanced non small-cell lung cancer (LA-NSCLC) patients treated with neoadjuvant concurrent hyperfractionated-accelerated chemoradiotherapy (HA-CRT) a retrospective analysis was performed. 88 patients were treated with HA-CRT followed by radical surgery. Predictive power of absolute oesophageal length, absolute and relative oesophageal volume included in the 95%-isodose, patient- and tumor-related factors for severity of acute esophagitis was assessed.

Findings

A total of 82 patients (93%) developed radiation-induced acute esophagitis. Grade 1 was documented in 1 (1%), grade 2 in 55 (67%), grade 3 in 23 (28%) and grade 4 in 3 (4%) patients, respectively. Absolute oesophageal volume included in the 95%-isodose (42.8 Gy) achieved 13.5 cm3 (range: 3 – 29 cm3). Of the tested variables in univariate analysis, absolute oesophageal volume included in the 95%-Isodose was found to be the only significant variable (p = 0.03) predicting severe acute esophagitis (CTC > grade 2). For this volume a gradation scale of the likelihood of severity was built.

Conclusion

Increase of absolute oesophageal volume included in the 95%-isodose correlates with severity of acute esophagitis in LA-NSCLC patients treated with neo-adjuvant concurrent HA-CRT.

Keywords:
Esophagitis; Hyperfractionated accelerated chemoradiotherapy; Lung cancer