title: Association between systemic chemotherapy before chemoradiation and increased risk of treatment-related pneumonitis in esophageal cancer patients treated with definitive chemoradiotherapy.
abstract: BACKGROUND
  There is limited information on risk factors for treatment-related pneumonitis in esophageal cancer patients.
  
  
  OBJECTIVE
  To determine factors associated with treatment-related pneumonitis in esophageal cancer patients treated with definitive chemoradiotherapy.
  
  
  METHODS
  We retrospectively reviewed clinical data from esophageal cancer patients treated with definitive chemoradiotherapy from 2000 to 2003. Demographic, clinical, and treatment-related data were collected for all patients. The time to occurrence of grade > or =2 pneumonitis was calculated from the end of radiotherapy. Univariate analyses were performed to determine the existence of any association between patient demographic, clinical, or treatment characteristics and pneumonitis.
  
  
  RESULTS
  In total, 96 patients were included in the study with a median follow-up of 8 months (range, <1-48 months). Among them, 23 patients also received an average of two cycles of systemic chemotherapy before the initiation of concurrent chemoradiation. The incidence of grade > or =2 pneumonitis was 22% at 1 year. Systemic chemotherapy before concurrent chemoradiation was significantly associated with an increased risk of grade > or =2 pneumonitis (p = 0.003), with the 1-year incidence of grade > or =2 pneumonitis for patients with and without systemic chemotherapy being 49 and 14%, respectively. No other clinical or dosimetric factors investigated were associated with the risk of grade > or =2 pneumonitis.
  
  
  CONCLUSIONS
  Systemic chemotherapy before concurrent chemoradiation was significantly associated with an increased risk of grade > or =2 pneumonitis, suggesting that induction chemotherapy may have sensitized the lung tissue to radiation damage in esophageal cancer patients.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Shulian
authors.initials: S
authors.lastname: Wang
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Xiong
authors.initials: X
authors.lastname: Wei
authors.forename: H Helen
authors.initials: HH
authors.lastname: Liu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: Chaosu
authors.initials: C
authors.lastname: Hu
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Alexandria
authors.initials: A
authors.lastname: Phan
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Radhe
authors.initials: R
authors.lastname: Mohan
authors.forename: James D
authors.initials: JD
authors.lastname: Cox
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D004307:Dose-Response Relationship, Radiation; D004359:Drug Therapy, Combination; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D017564:Radiation Pneumonitis / Q000453:epidemiology / Q000209:etiology*; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000964:Antimetabolites, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel; D005472:Fluorouracil