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Reduced frequency and severity of radiation esophagitis without marginal failure risk by contralateral esophagus sparing IMRT in stage III non-small cell lung cancer patients undergoing definitive concurrent chemoradiotherapy.
- Source :
-
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Oct; Vol. 199, pp. 110436. Date of Electronic Publication: 2024 Jul 17. - Publication Year :
- 2024
-
Abstract
- Purpose: Radiation esophagitis is frequent and annoying toxicity in high dose thoracic radiation therapy. Contalateral esophagus sparing intensity modulated radiation therapy (CES-IMRT) has been proposed to mitigate this problem, and this is to report the impact of CES-IMRT in definitive concurrent chemoradiotherapy (dCCRT) for lung cancer patients.<br />Materials and Methods: From January 2021 till May 2023, 183 stage III non-small cell lung cancer patients underwent dCCRT. Esophagus was located within 1 cm from internal target volume in 159 patients. We comparatively evaluated the frequency and severity of esophagitis by pain-killer usage, analgesic quantification algorithm (AQA) score, and failure patterns in 159 CES-necessary patients.<br />Results: All patients underwent dCCRT (66 Gy in 30 fractions with concurrent chemotherapy). Actual CES-IMRT application was determined based on the discretion of responsible radiation oncologists: CES-applied in 41 patients; and CES-unapplied in 118. CES-applied patients experienced pain events less frequently (pain-killer usage: 53.7 % vs. 77.1 %, p = 0.008) and less severely (AQA score of 2-3: 39.0 % vs. 68.6 %, p = 0.002). On multivariate analyses, overlapping volume of esophagus and planning target (HR = 1.32, 95 % CI 1.12-1.55, p = 0.001) and CES-IMRT application (HR = 0.31, 95 % CI 0.13-0.76, p = 0.010) were associated with AQA score of 2-3 less frequently. There were no differences in failure pattern, progression-free survival, and overall survival.<br />Conclusions: CES-IMRT application resulted in less frequent and less severe pain events without compromising oncologic outcomes. Further studies, preferably in a randomized fashion, would be desired.<br />Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Subjects :
- Humans
Male
Female
Middle Aged
Aged
Adult
Neoplasm Staging
Esophagus radiation effects
Esophagus pathology
Organ Sparing Treatments methods
Aged, 80 and over
Retrospective Studies
Severity of Illness Index
Esophagitis etiology
Carcinoma, Non-Small-Cell Lung pathology
Carcinoma, Non-Small-Cell Lung therapy
Carcinoma, Non-Small-Cell Lung radiotherapy
Chemoradiotherapy adverse effects
Chemoradiotherapy methods
Radiotherapy, Intensity-Modulated adverse effects
Radiotherapy, Intensity-Modulated methods
Lung Neoplasms pathology
Lung Neoplasms therapy
Lung Neoplasms radiotherapy
Radiation Injuries etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0887
- Volume :
- 199
- Database :
- MEDLINE
- Journal :
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 39029592
- Full Text :
- https://doi.org/10.1016/j.radonc.2024.110436