title: Maximal neutropenia during chemotherapy and radiotherapy is significantly associated with the development of acute radiation-induced dysphagia in lung cancer patients.
abstract: BACKGROUND
  Acute dysphagia is a distressing dose-limiting toxicity after concurrent chemoradiation or high-dose radiotherapy for lung cancer. We therefore identified factors associated with the occurrence of acute dysphagia in lung cancer patients receiving radiotherapy alone or combined with chemotherapy.
  
  
  METHODS
  Radiotherapy, chemotherapy and patient characteristics were analyzed using ordinal regression analysis as possible predictors for acute dysphagia (CTCAE 3.0) in 328 lung cancer patients treated with curative intent.
  
  
  RESULTS
  The most significant association was seen between the maximal grade of neutropenia during chemoradiation and dysphagia, with an odds ratio increasing from 1.49 [95% confidence interval (CI) 0.63-3.54, P = 0.362] for grade 1-2 neutropenia to 19.7 (95% CI 4.66-83.52, P < 0.001) for patients with grade 4 neutropenia. Twice-daily schedule, mean esophageal dose and administration of chemotherapy were significant predictive factors. By combining these factors, a high-performance predictive model was made. On an individual patient level, 64% of patients were correctly classified and only 1.2% of patients were misclassified by more than one grade.
  
  
  CONCLUSIONS
  The maximal neutrophil toxicity during concurrent chemotherapy and radiotherapy is strongly associated with the development of acute dysphagia. A multivariate predictive model was developed.
authors.affiliation: Department of Radiotherapy, MAASTRO clinic, GROW, University Hospital Maastricht, Maastricht, The Netherlands. dirk.deruysscher@maastro.nl
authors.forename: D
authors.initials: D
authors.lastname: De Ruysscher
authors.forename: C
authors.initials: C
authors.lastname: Dehing
authors.forename: R-H
authors.initials: RH
authors.lastname: Bremer
authors.forename: S M
authors.initials: SM
authors.lastname: Bentzen
authors.forename: F
authors.initials: F
authors.lastname: Koppe
authors.forename: M
authors.initials: M
authors.lastname: Pijls-Johannesma
authors.forename: L
authors.initials: L
authors.lastname: Harzée
authors.forename: A
authors.initials: A
authors.lastname: Minken
authors.forename: R
authors.initials: R
authors.lastname: Wanders
authors.forename: M
authors.initials: M
authors.lastname: Hochstenbag
authors.forename: A-M
authors.initials: AM
authors.lastname: Dingemans
authors.forename: L
authors.initials: L
authors.lastname: Boersma
authors.forename: E
authors.initials: E
authors.lastname: van Haren
authors.forename: W
authors.initials: W
authors.lastname: Geraedts
authors.forename: C
authors.initials: C
authors.lastname: Pitz
authors.forename: J
authors.initials: J
authors.lastname: Simons
authors.forename: Bg
authors.initials: B
authors.lastname: Wouters
authors.forename: J-F
authors.initials: JF
authors.lastname: Rosier
authors.forename: P
authors.initials: P
authors.lastname: Lambin
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000532:radiotherapy; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies