title: Predictors of acute esophagitis in lung cancer patients treated with concurrent three-dimensional conformal radiotherapy and chemotherapy.
abstract: OBJECTIVE
  To evaluate the risk factors for acute esophagitis (AET) in lung cancer patients treated with concurrent 3D-CRT and chemotherapy.
  
  
  METHODS
  Data from 100 patients treated with concurrent chemoradiotherapy with a mean dose of 62.05 +/- 4.64 Gy were prospectively evaluated. Esophageal toxicity was graded according to criteria of the Radiation Therapy Oncology Group. The following dosimetric parameters were analyzed: length and volume of esophagus in treatment field, percentage of esophagus volume treated to >or=10, >or=20, >or=30, >or=35, >or=40, >or=45, >or=50, >or=55, and >or=60 Gy, and the maximum (D(max)) and mean doses (D(mean)) delivered to the esophagus. Also, we developed an esophagitis index (EI) to account the esophagitis grades over treatment time.
  
  
  RESULTS
  A total of 59 patients developed AET (Grade 1, 26 patients; Grade 2, 29 patients; and Grade 3, 4 patients). V50 was associated with AET duration (p = 0.017), AET Grade 1 duration (p = 0.016), maximum analgesia (p = 0.019), esophagitis index score (p = 0.024), and AET Grade >or=1 (p = 0.058). If V50 is <30% there is a 47.3% risk of AET Grade >or=1, which increases to 73.3% if V50 is >or=30% (p = 0.008). The predictive abilities of models (sensitivity and specificity) were calculated by receiver operating characeristic curves.
  
  
  CONCLUSIONS
  According to the receiver operating characeristic curve analysis, the 30% of esophageal volume receiving >or=50 Gy was the most statistically significant factor associated with AET Grade >or=1 and maximum analgesia (A(max)). There was an association with AET Grade >or=2 but it did not achieve statistical significance (p = 0.076).
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, IMAS, Barcelona, Spain. nrodriguez@imas.imim.es
authors.forename: Núria
authors.initials: N
authors.lastname: Rodríguez
authors.forename: Manuel
authors.initials: M
authors.lastname: Algara
authors.forename: Palmira
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authors.lastname: Foro
authors.forename: Marti
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authors.lastname: Lacruz
authors.forename: Anna
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authors.lastname: Reig
authors.forename: Ismael
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authors.lastname: Membrive
authors.forename: Joan
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authors.lastname: Lozano
authors.forename: José Luis
authors.initials: JL
authors.lastname: López
authors.forename: Jaime
authors.initials: J
authors.lastname: Quera
authors.forename: Enric
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authors.lastname: Fernández-Velilla
authors.forename: Xavier
authors.initials: X
authors.lastname: Sanz