High-dose preoperative chemoradiotherapy in esophageal cancer patients does not increase postoperative pulmonary complications: correlation with dose-volume histogram parameters.
OBJECTIVE
To investigate the association of high-dose preoperative chemoradiotherapy (CRT) and dose-volume histogram (DVH) parameters of lungs with incidence of postoperative pulmonary complications and to identify predictive clinical factors of pulmonary complications.


METHODS
Data of 65 patients were collected retrospectively. Thirty-five patients underwent transthoracic esophagectomy (TTE) alone and 30 received cisplatin and 5-fluorouracil, concomitant with radiotherapy, median dose 66Gy, and followed by TTE. From the DVH for each lung alone and for both lungs together as one organ we generated total lung volume, mean radiotherapy dose, relative and absolute volumes receiving more than a threshold dose, and relative and absolute volumes receiving less than a threshold dose. Postoperative pulmonary complications were defined as pneumonia or respiratory failure.


RESULTS
Sixty percent of the patients in the TTE alone group had postoperative pulmonary complications versus 63% in the CRT+TTE group. Postoperative mortality was 8.6% and 16.7% in the respective patient groups (p=NS). None of the DVH parameters was associated with postoperative pulmonary complications. Squamous cell carcinoma was an adverse factor related to increased postoperative pulmonary complications.


CONCLUSIONS
High-dose preoperative CRT was not associated with increased postoperative pulmonary complications in this cohort of esophageal cancer patients.
Hurmuzlu
Meysan
M
Department of Oncology, Førde Central Hospital, Førde, Norway. meysan.hurmuzlu@helse-bergen.no
Øvrebø
Kjell
K
Wentzel-Larsen
Tore
T
Muren
Ludvig Paul
LP
Viste
Asgaut
A
Smaaland
Rune
R
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D002945:Cisplatin; D005472:Fluorouracil