Risk factors for acute esophagitis in non–small-cell lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy

Purpose: To determine the risk factors for acute esophagitis (AE) in non–small-cell lung cancer (NSCLC) patients treated with concurrent chemotherapy (CCT) and three-dimensional conformal radiotherapy (3D-CRT).

Methods and Materials: Clinical data were retrospectively analyzed for 215 NSCLC patients treated with CCT and 3D-CRT during 2000–2003, 127 of whom also had induction chemotherapy (ICT). Carboplatin and paclitaxel were the most commonly used agents for both ICT and CCT. The median prescription dose of radiotherapy was 63.5 Gy in 35 fractions. AE was graded during each treatment week and 1-month follow-up visits. The factors related to clinical and disease characteristics, CCT and 3D-CRT treatments, and treatment planning were reviewed and analyzed for their association with Grade ≥3 AE using univariate and multivariate logistic tests.

Results: The rate of any grade AE was 93.0% and of Grade ≥3 was 20.5%. Univariate analyses showed that none of the clinical factors was significantly associated with Grade ≥3 AE. However, the mean radiation dose to the esophagus, the absolute esophageal volume treated above 15 Gy (aV15) through aV45 Gy, and the relative esophagus volume treated above 10 Gy (rV10) through rV45 Gy were significant risk factors for Grade ≥3 AE. Only rV20 was retained as the single risk factor in multivariate analyses.

Conclusions: The risk of AE in the NSCLC patients treated with CCT and 3D-CRT was primarily determined by dosimetric factors. These factors should be carefully considered during treatment planning to minimize the incidence of AE.

Keywords:  Acute esophagitis , Concurrent chemotherapy , Three-dimensional conformal radiotherapy , Non–small-cell lung cancer , Dose–volume of esophagus