title: Acute esophagus toxicity in lung cancer patients after intensity modulated radiation therapy and concurrent chemotherapy.
abstract: OBJECTIVE
  The purpose of this study was to investigate the dose-effect relation between acute esophageal toxicity (AET) and the dose-volume parameters of the esophagus after intensity modulated radiation therapy (IMRT) and concurrent chemotherapy for patients with non-small cell lung cancer (NSCLC).
  
  
  METHODS
  One hundred thirty-nine patients with inoperable NSCLC treated with IMRT and concurrent chemotherapy were prospectively analyzed. The fractionation scheme was 66 Gy in 24 fractions. All patients received concurrently a daily dose of cisplatin (6 mg/m(2)). Maximum AET was scored according to Common Toxicity Criteria 3.0. Dose-volume parameters V5 to V70, D(mean) and D(max) of the esophagus were calculated. A logistic regression analysis was performed to analyze the dose-effect relation between these parameters and grade ≥ 2 and grade ≥ 3 AET. The outcome was compared with the clinically used esophagus V35 prediction model for grade ≥ 2 after radical 3-dimensional conformal radiation therapy (3DCRT) treatment.
  
  
  RESULTS
  In our patient group, 9% did not experience AET, and 31% experienced grade 1 AET, 38% grade 2 AET, and 22% grade 3 AET. The incidence of grade 2 and grade 3 AET was not different from that in patients treated with CCRT using 3DCRT. The V50 turned out to be the most significant dosimetric predictor for grade ≥ 3 AET (P=.012). The derived V50 model was shown to predict grade ≥ 2 AET significantly better than the clinical V35 model (P<.001).
  
  
  CONCLUSIONS
  For NSCLC patients treated with IMRT and concurrent chemotherapy, the V50 was identified as most accurate predictor of grade ≥ 3 AET. There was no difference in the incidence of grade ≥ 2 AET between 3DCRT and IMRT in patients treated with concurrent chemoradiation therapy.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Margriet
authors.initials: M
authors.lastname: Kwint
authors.forename: Wilma
authors.initials: W
authors.lastname: Uyterlinde
authors.forename: Jasper
authors.initials: J
authors.lastname: Nijkamp
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.forename: Josien
authors.initials: J
authors.lastname: de Bois
authors.forename: Jan-Jakob
authors.initials: JJ
authors.lastname: Sonke
authors.forename: Michel
authors.initials: M
authors.lastname: van den Heuvel
authors.forename: Joost
authors.initials: J
authors.lastname: Knegjens
authors.forename: Marcel
authors.initials: M
authors.lastname: van Herk
authors.forename: José
authors.initials: J
authors.lastname: Belderbos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D004947:Esophagus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000528:radiation effects; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects*; D011446:Prospective Studies; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D013116:Spinal Cord / Q000000981:diagnostic imaging
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin