1. Severe late esophagus toxicity in NSCLC patients treated with IMRT and concurrent chemotherapy.
- Author
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Chen C, Uyterlinde W, Sonke JJ, de Bois J, van den Heuvel M, and Belderbos J
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung pathology, Chemoradiotherapy adverse effects, Chemoradiotherapy methods, Cisplatin adverse effects, Cisplatin therapeutic use, Cohort Studies, Esophagus drug effects, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness pathology, Neoplasm Staging, Netherlands, Radiation Injuries diagnosis, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated methods, Retrospective Studies, Risk Assessment, Survival Analysis, Time Factors, Carcinoma, Non-Small-Cell Lung therapy, Esophagus radiation effects, Lung Neoplasms therapy, Radiation Injuries pathology, Radiotherapy, Intensity-Modulated adverse effects
- 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., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2013
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