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Acute and Late Esophageal Toxicity After SABR to Thoracic Tumors Near or Abutting the Esophagus.

Authors :
Sodji QH
Ko R
von Eyben R
Owen SG
Capaldi DPI
Bush K
Binkley MS
Alrowais F
Pickthorn B
Maxim PG
Gensheimer MF
Diehn M
Loo BW Jr
Source :
International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2022 Apr 01; Vol. 112 (5), pp. 1144-1153. Date of Electronic Publication: 2021 Dec 20.
Publication Year :
2022

Abstract

Purpose: Our purpose was to evaluate the incidence of acute and late esophageal toxicity in patients with thoracic tumors near or abutting the esophagus treated with SABR.<br />Methods and Materials: Among patients with thoracic tumors treated with SABR, we identified those with tumors near or abutting the esophagus. Using the linear-quadratic model with an α/ß ratio of 10, we determined the correlation between dosimetric parameters and esophageal toxicity graded using the Common Terminology Criteria for Adverse Events, version 5.0.<br />Results: Out of 2200 patients treated with thoracic SABR, 767 patients were analyzable for esophageal dosimetry. We identified 55 patients with tumors near the esophagus (52 evaluable for esophagitis grade) and 28 with planning target volume (PTV) overlapping the esophagus. Dose gradients across the esophagus were consistently sharp. Median follow-up and overall survival were 16 and 23 months, respectively. Thirteen patients (25%) developed temporary grade 2 acute esophageal toxicity, 11 (85%) of whom had PTV overlapping the esophagus. Symptoms resolved within 1 to 3 months in 12 patients and 6 months in all patients. No grade 3 to 5 toxicity was observed. Only 3 patients (6%) developed late or persistent grade 2 dysphagia or dyspepsia of uncertain relationship to SABR. The cumulative incidence of acute esophagitis was 15% and 25% at 14 and 60 days, respectively. Acute toxicity correlated on univariate analysis with esophageal D <subscript>max</subscript> , D <subscript>1cc</subscript> , D <subscript>2cc</subscript> , D <subscript>max</subscript> /D <subscript>prescription</subscript> , and whether the PTV was overlapping the esophagus. Esophageal D <subscript>max</subscript> (BED <subscript>10</subscript> ) <62 Gy, D <subscript>1cc</subscript> (BED <subscript>10</subscript> ) <48 Gy, D <subscript>2cc</subscript> (BED <subscript>10</subscript> ) <43 Gy, and D <subscript>max</subscript> /D <subscript>prescription</subscript> <85% were associated with <20% risk of grade 2 acute esophagitis. Only 2 local recurrences occurred.<br />Conclusions: Although 25% of patients with tumors near the esophagus developed acute esophagitis (39% of those with PTV overlapping the esophagus), these toxicities were all grade 2 and all temporary. This suggests the safety and efficacy of thoracic SABR for tumors near or abutting the esophagus when treating with high conformity and sharp dose gradients.<br /> (Copyright © 2021. Published by Elsevier Inc.)

Details

Language :
English
ISSN :
1879-355X
Volume :
112
Issue :
5
Database :
MEDLINE
Journal :
International journal of radiation oncology, biology, physics
Publication Type :
Academic Journal
Accession number :
34942312
Full Text :
https://doi.org/10.1016/j.ijrobp.2021.12.008