title: Esophageal tolerance to high-dose stereotactic radiosurgery.
abstract: OBJECTIVE
  Esophageal tolerance is needed to guide the safe administration of stereotactic radiosurgery (SRS). We evaluated comprehensive dose-volume parameters of acute esophageal toxicity in patients with spinal metastasis treated with SRS.
  
  
  METHODS
  From May 2008 to May 2011, 30 cases in 27 patients with spinal metastasis received single fraction SRS to targets neighboring esophagus. Endpoints evaluated include length (mm), volume (mL), maximal dose (Gy), and series of dose-volume thresholds from the dose-volume histogram (volume of the organ treated beyond a threshold dose).
  
  
  RESULTS
  The median time from the start of irradiation to development of esophageal toxicity was 2 weeks (range, 1 to 12 weeks). Six events of grade 1 esophageal toxicity occurred. No grade 2 or higher events were observed. V15 of external surface of esophagus was found to predict acute esophageal toxicity revealed by multivariate analysis (odds radio = 1.272, p = 0.047).
  
  
  CONCLUSIONS
  In patients with spinal metastasis who received SRS for palliation of symptoms, the threshold dose-volume parameter associated with acute esophageal toxicity was found to be V15 of external surface of esophagus. Restrict V15 to external surface of esophagus as low as possible might be safe and feasible in radiosurgery.
authors: Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors: Bo Mi
authors: BM
authors: Lee
authors: Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors: Sei Kyung
authors: SK
authors: Chang
authors: Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors: Seung Young
authors: SY
authors: Ko
authors: Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors: Seung Hoon
authors: SH
authors: Yoo
authors: Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors: Hyun Soo
authors: HS
authors: Shin
keywords: Esophagus; Radiation tolerance; Stereotactic radiosurgery