Treatment-Related Pneumonitis and Acute Esophagitis in Non–Small-Cell Lung Cancer Patients Treated With Chemotherapy and Helical Tomotherapy

Purpose

To assess clinical outcomes and complications in patients with non–small-cell lung cancer (NSCLC) treated with helical tomotherapy (HT) with or without chemotherapy.

Methods and Materials

Data from 37 NSCLC patients treated between January 2007 and August 2008 were analyzed retrospectively. Twenty-eight patients had Stage III disease. Concurrent and neoadjuvant chemotherapy was given to 24 and 14 patients, respectively. Radiotherapy was delivered to a total dose of 60–70.4 Gy at 2.0–2.4 Gy per fraction to the gross tumor volume and 50–64 Gy at 1.8–2.0 Gy per fraction to the planning target volume.

Results

With a median follow-up of 18 months (range, 6–27 months), 2-year local control and overall survival rates were 63% and 56% for all 37 patients, respectively, and were 78% and 75% for the patients with Stage III disease who received concurrent chemoradiotherapy alone. Acute esophagitis and treatment-related pneumonitis (TRP) ≥Grade 3 occurred in 5 and 7 patients, respectively. Four patients died of treatment-related death (TRD) after HT. In univariate analysis, poor performance status, total lung V₅, contralateral lung (CL) V₅, and V₁₀ were associated with TRD. Only CL V₅ remained significant in the multivariate analysis (p = 0.029).

Conclusions

HT with chemotherapy has shown promising clinical outcomes, esophagitis, and TRPs. However, HT has produced a somewhat high rate of fatal pulmonary complications. Our data suggest that CL V₅ should be considered and kept as low as possible (<60%) in addition to the conventional dosimetric factors.

Non–small-cell lung cancer, Tomotherapy, IMRT, Pneumonitis, Toxicity