title: Acute esophagitis for patients with local-regional advanced non small cell lung cancer treated with concurrent chemoradiotherapy.
abstract: OBJECTIVE
  Esophagitis is common in patients treated with definitive radiotherapy for local-regional advanced non small cell lung cancer (NSCLC). The purpose of this study was to estimate the dose-effect relationship using clinical and dosimetric parameters in patients receiving intensity modulated radiotherapy (IMRT) and concomitant chemotherapy (CCT).
  
  
  METHODS
  Between 2009 and 2013, 117 patients with stages IIB-IIIB NSCLC were treated in a multicenter randomized phase II trial with 2 cycles of induction chemotherapy followed by IMRT and CCT. The esophagitis was prospectively scored using the Common Toxicity Criteria 3.0. Clinical and dosimetric variables were analyzed for the correlation with grade ⩾2 esophagitis through logistic regression.
  
  
  RESULTS
  Grade 2 esophagitis was experienced by 31 (27%). All models including gender, institution, a dosimetric parameter and a position parameter were significantly associated with esophagitis. The two models using the relative esophagus volume irradiated above 40 Gy (V40, OR=2.18/10% volume) or the length of esophagus irradiated above 40 Gy (L40, OR=4.03/5 cm) were optimal. The upper part of esophagus was more sensitive and females experienced more toxicity than men.
  
  
  CONCLUSIONS
  V40 and L40 were most effective dosimetric predictors of grade ⩾2 esophagitis. The upper part of esophagus was more sensitive.
authors.affiliation: Department of Radiation Oncology, Guangdong General Hospital & Guangdong Academy of Medical Science, PR China; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Yi
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Brink
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Knap
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Azza A
authors.initials: AA
authors.lastname: Khalil
authors.affiliation: Department of Oncology, Vejle Hospital, Sygehus Lillebaelt, Denmark.
authors.forename: Christa H
authors.initials: CH
authors.lastname: Nyhus
authors.affiliation: Department of Oncology, Aalborg University Hospital, Denmark.
authors.forename: Tine
authors.initials: T
authors.lastname: McCulloch
authors.affiliation: Department of Oncology, Herlev University Hospital, Denmark.
authors.forename: Bente
authors.initials: B
authors.lastname: Holm
authors.affiliation: Guangdong Lung Cancer Institute, PR China.
authors.forename: Yi-long
authors.initials: YL
authors.lastname: Wu
authors.affiliation: Department of Oncology, Odense University Hospital, Denmark.
authors.forename: Tine
authors.initials: T
authors.lastname: Schytte
authors.affiliation: Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark. Electronic address: olfred.hansen@rsyd.dk.
authors.forename: Olfred
authors.initials: O
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D004941:Esophagitis / Q000209:etiology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects
keywords: Acute esophagitis; Concurrent chemoradiotherapy; IMRT; Non small cell lung cancer