title: Dose-volume analysis for respiratory toxicity in intrathoracic esophageal cancer patients treated with definitive chemoradiotherapy using extended fields.
abstract: OBJECTIVE
  We evaluated the relationship between dosimetric parameters (DPs) and the incidence of radiation pneumonitis (RP) and investigated the feasibility of a proposed treatment planning technique with the potential of reducing RP in esophageal cancer patients treated with definitive chemoradiotherapy using extended fields.
  
  
  METHODS
  A total of 149 patients with locally advanced esophageal cancer were prospectively enrolled for extended-field radiotherapy (EFRT) to three-field regional lymphatics between September 2004 and June 2009. We retrospectively reviewed 86 consecutive patients who were treated with a total dose of 50.4 Gy (plus an optional 9 Gy boost) and were available for dose-volume analysis. Lung DPs of patients in the Grade 0-1 RP (RPG≤1) group and the Grade 2-5 RP (RPG≥2) group were compared. We compared the proposed plan with the conventional plan to 50.4 Gy on DPs for each case.
  
  
  RESULTS
  Of these 86 patients, 10 (12%) developed RPG≥2 (Grade 2, n = 2 patients; Grade 3, n = 3; Grade 4, n = 3; Grade 5, n = 2). The patients in the RPG≤1 group showed significantly lower (P < 0.05) V5 and V10 values for the whole lung compared with those in the RPG≥2 group. There were two advantages gained from the proposed plan for V5 (<55%) and V10 (< 37%) values and the conformity of the PTV.
  
  
  CONCLUSIONS
  The increase in the volume of the lung exposed to low doses of EFRT was found to be associated with the incidence of RP. Our proposed plan is likely to reduce the incidence of RP.
authors: Department of Radiation Oncology, Keiyukai Sapporo Hospital, 1-1, 14 chome, Hondori, Shiroishi-ku, Sapporo, 003-0027, Japan.
authors: Satoshi
authors: S
authors: Tanabe
authors: Miyako
authors: M
authors: Myojin
authors: Shinichi
authors: S
authors: Shimizu
authors: Masaharu
authors: M
authors: Fujino
authors: Hiroaki
authors: H
authors: Takahashi
authors: Hiroki
authors: H
authors: Shirato
authors: Yoichi M
authors: YM
authors: Ito
authors: Masayori
authors: M
authors: Ishikawa
authors: Masao
authors: M
authors: Hosokawa
mesh_terms: D015984:Causality; D059248:Chemoradiotherapy / Q000401:mortality*; D015897:Comorbidity; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D017564:Radiation Pneumonitis / Q000401:mortality*; D011874:Radiometry / Q000706:statistics & numerical data*; D011879:Radiotherapy Dosage; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: chemoradiation; dose-volume histogram; dosimetric parameter; esophageal cancer; extended-field; radiation pneumonitis
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