Association of clinical and dosimetric factors with postoperative pulmonary complications in esophageal cancer patients receiving intensity-modulated radiation therapy and concurrent chemotherapy followed by thoracic esophagectomy.
BACKGROUND
To investigate the association between clinical/dosimetric factors and postoperative pulmonary complications (PPC) in esophageal cancer patients undergoing neoadjuvant chemotherapy and intensity-modulated radiation therapy (IMRT) followed by thoracic esophagectomy.


METHODS
The data from 52 patients receiving combined modality treatment were analyzed. Chemotherapy was taxane-based in 43 and 5-fluorouracil-based in 9 patients. IMRT (40-45 Gy, median 40 Gy, at 1.8-2 Gy per fraction) was given using a 3-5-beam arrangement. Surgery consisted of open or minimally invasive esophagectomy. The dosimetric parameters were generated from lung dose-volume histogram computed by the treatment planning software. PPC was defined as pneumonia or respiratory insufficiency within 30 days after surgery. Statistical correlations were analyzed between clinical/dosimetric factors and PPC.


RESULTS
The incidence of PPC was 34.6%. No patients died of PPC. Two patients (3.8%) became ventilator dependent. In univariate analyses, preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity before surgery were significantly associated with PPC (P = 0.02 and 0.04, respectively). None of the dosimetric factors predicted development of PPC. For the 51 patients undergoing right transthoracic surgery, higher absolute spared volume of the right lung receiving 15 Gy was significantly associated with PPC (P = 0.03). In multivariate analysis, preoperative FEV1 was the only independent factor associated with PPC (P = 0.002).


CONCLUSIONS
Preoperative rather than prechemoradiation FEV1 predicts development of PPC. Reducing the absolute volume of the right lung that is irradiated might decrease the risk of PPC for patients receiving right transthoracic surgery.
Hsu
Feng-Ming
FM
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Lee
Yung-Chie
YC
Lee
Jang-Ming
JM
Hsu
Chih-Hung
CH
Lin
Chia-Chi
CC
Tsai
Yu-Chieh
YC
Wu
Jian-Kuen
JK
Cheng
Jason Chia-Hsien
JC
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D010865:Pilot Projects; D011874:Radiometry; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D002945:Cisplatin