title: Acute esophagitis and late lung toxicity in concurrent chemoradiotherapy trials in patients with locally advanced non-small-cell lung cancer: analysis of the radiation therapy oncology group (RTOG) database.
abstract: BACKGROUND
  We analyzed time course and factors associated with acute esophagitis (ES) and late lung toxicity (PN), as well as any association between ES and PN in patients (pts) with non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiation (chemo-RT) on the Radiation Therapy Oncology Group (RTOG) trials.
  
  
  METHODS
  Multivariable analysis was used to investigate factors associated with ES or PN.
  
  
  RESULTS
  Patients (n = 528) received standard fractionated (SFX; 63 Gy) or hyperfractionated (HFX; 69.6 Gy) radiation therapy (RT) with cisplatin-based chemotherapy. Grade > 2 ES developed in 75% of pts; Grade > 3 ES, in 34%. Nineteen percent of pts developed ES by the first, 32% by the second, and 33% by the third month (and for Grade > 3 PN, 9% by 6 months, 15% by year 1, and 18% by year 2). Any PN developed in 59% of pts; Grade > 2, in 39%; Grade > 3, in 18%; and lethal PN, in 2%. Grade > 2 PN was associated with increasing RT dose and Grade > 3 PN, with HFX RT. No association was seen with ES. Grade > 3 ES was less likely to occur in non-whites and more likely, in pts treated with HFX RT.
  
  
  CONCLUSIONS
  Most (95%) pts developed ES, and 33% had severe ES, peaking within the first or second month of RT. PN developed in 57% of pts, with 18% experiencing Grade > 3 PN, with most diagnosed by 1 year from RT. No relationship was observed between 1 toxicity (ES or PN) as predictor of the other. HFX RT was associated with more severe PN or ES.
authors: Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. maria.werner-wasik@jeffersonhospital.org
authors: Maria
authors: M
authors: Werner-Wasik
authors: Rebecca
authors: R
authors: Paulus
authors: Walter J
authors: WJ
authors: Curran
authors: Roger
authors: R
authors: Byhardt
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000175:diagnosis / Q000209:etiology*; D005047:Etoposide / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin