Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2005; 11(17): 2626-2629
Published online May 7, 2005. doi: 10.3748/wjg.v11.i17.2626
Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity
Wen-Bo Qiao, Yan-Hui Zhao, Yan-Bin Zhao, Rui-Zhi Wang
Wen-Bo Qiao, Yan-Hui Zhao, Yan-Bin Zhao, Rui-Zhi Wang, Department of Radiotherapy Oncology, Tumor Hospital of Harbin Medical University, Harbin 150040, Heilongjiang Province, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Wen-Bo Qiao, Department of Radiotherapy Oncology, Tumor Hospital of Harbin Medical University, Harbin 150040, Heilongjiang Province, China. wenboq@163.com
Telephone: +86-451-86298535 Fax: +86-451-86663760
Received: December 17, 2004
Revised: December 18, 2004
Accepted: February 18, 2005
Published online: May 7, 2005
Abstract

AIM: To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during three-dimensional conformal radiotherapy (3D-CRT).

METHODS: We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria.

RESULTS: Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ≥60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P = 0.0001<0.01). However, no grade 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P = 0.0001<0.01).

CONCLUSION: Concurrent chemotherapy and the maximal esophageal point dose ≥60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT.

Keywords: 3D-CRT; Non-small-cell lung cancer; Chemo-therapy; Esophagitis