Factors Associated With Severe Acute Esophagitis From Hyperfractionated Radiotherapy With Concurrent Chemotherapy for Limited-Stage Small-Cell Lung Cancer
Received 13 June 2008; received in revised form 26 August 2008; accepted 17 September 2008. published online 11 December 2008.
Purpose
To describe incidence and identify factors associated with development of severe acute esophagitis during hyperfractionated radiotherapy with concurrent chemotherapy (BID-CRT) in patients with limited-stage small-cell lung cancer (SCLC).
Methods and Materials
Retrospective cohort analysis of patient-, tumor-, and treatment-related variables was performed to identify factors associated with Radiation Therapy Oncology Group (RTOG) Grade 3 acute esophagitis. Twice-daily chemoradiotherapy (BID-CRT) involved 45 Gy at 1.5 Gy per fraction, treated twice daily with concurrent platinum-based chemotherapy. Logistic regression analyses were used to identify factors associated with esophagitis.
Results
Between June 1999 and June 2007, 48 patients underwent curative intent BID-CRT for SCLC and were included in the analysis. Median radiotherapy dose was 45 Gy (range, 42–51 Gy) delivered with a median 4 cycles of chemotherapy (range, 2–6). RTOG Grade 3 acute esophagitis developed in 11 patients. No patient developed Grade 4 or 5 esophagitis. Simple logistic regression analyses demonstrated a highly significant association between Grade 3 acute esophagitis and mean esophageal dose (p = 0.002) as well as relative volume dosimetric area under curve (RV-AUC; p = 0.004). Using multiple regression analysis, RV-AUC was identified as the only factor associated with Grade 3 esophagitis (p = 0.004). The most strongly associated dosimetric volume was the V15 (Grade 3 esophagitis rates of 15% vs. 64% for V15 <60% versus ≥60%, respectively).
Conclusions
RV-AUC is the factor most associated with development of Grade 3 acute esophagitis in limited stage SCLC patients receiving BID-CRT.
∗Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
†Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
‡Department of Medicine, Division of Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina
Reprint requests to: Anand K. Sharma, M.D., Medical University of South Carolina, Department of Radiation Oncology, 169 Ashley Avenue, Charleston SC 29425; Tel: (843) 792-3271; Fax: (843) 792-5498
Supported with resources and the use of facilities at the Ralph H. Johnson Veterans' Affairs Medical Center, Charleston, South Carolina.
Presented at the 90th Annual Meeting of the American Radium Society, Laguna Niguel, California, May 3, 2008.
ABSTRACT