title: Correlation of dosimetric and clinical factors with the development of esophagitis and radiation pneumonitis in patients with limited-stage small-cell lung carcinoma.
abstract: BACKGROUND
  The purpose of the study was to correlate clinical and dosimetric factors with the development of esophagitis and radiation pneumonitis in patients with limited-stage small-cell lung carcinoma (LS SCLC).
  
  
  METHODS
  One hundred eighteen patients who received curative intent chemoradiotherapy for LS SCLC and had electronically archived radiation treatment plans were included. The medical charts were reviewed for clinical data. The treatment plan was reviewed for critical structure delineation and dose delivered. Treatment planning data were analyzed using Computational Environment for Radiotherapy Research (V3.3). Dosimetric parameters were correlated with the risk of toxicity using Spearman rank correlation.
  
  
  RESULTS
  Radiotherapy dose was 40 Gy in 15 fractions (fx) (n = 80) and 45 Gy in 30 fractions twice per day (n = 38). The 6-month cumulative incidence of Grade ≥ 2 radiation pneumonitis was 6.5% and 7.9% for the 40 Gy/15 fx and 45 Gy/30 fx groups, respectively (P = .40). The 3-month cumulative incidence of Grade 3 esophagitis was 7.5% and 13.2% for the 40 Gy/15 fx and 45 Gy/30 fx groups, respectively (P = .31). Grade ≥ 3 pneumonitis was correlated with volume of lung receiving 20 Gy (V20) and mean lung dose. Grade ≥ 3 esophagitis was correlated with mean esophagus dose and minimum dose to the hottest 45% of the esophagus (D45).
  
  
  CONCLUSIONS
  Mean lung dose and V20 were significant predictors of radiation pneumonitis in LS SCLC. Mean esophageal dose and D45 were significant predictors of esophagitis. These 2 treatment schedules have similar toxicity profiles.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada. Electronic address: Meredith.Giuliani@rmp.uhn.on.ca.
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Giuliani
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Lindsay
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: Jennifer Y Y
authors.initials: JY
authors.lastname: Kwan
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sun
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Le
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Brade
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hope
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects*; D004941:Esophagitis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D017564:Radiation Pneumonitis / Q000453:epidemiology / Q000209:etiology*; D011874:Radiometry; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000532:radiotherapy*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Dosimetry; Esophagitis; Radiation pneumonitis; Small Cell Lung Cancer; Toxicity