title: Esophageal Dose Tolerance in Patients Treated With Stereotactic Body Radiation Therapy.
abstract: Mediastinal critical structures such as trachea, bronchus, esophagus, and heart are among the dose-limiting factors for stereotactic body radiation therapy (SBRT) to central lung lesions. The purpose of this study was to characterize the risk of esophagitis for patients treated with SBRT and to develop a statistical dose-response model to assess the equivalent uniform dose, D10%, D5cc, D1cc, and Dmax, to the esophagus and the risk of toxicity. Toxicity outcomes of a dose-escalation study of 56 patients who had taken CyberKnife treatment from 45-60Gy in 3-7 fractions at the Erasmus MC-Daniel den Hoed Cancer Center were utilized to create the dose-response model for esophagus. A total of 5 grade 2 esophageal complications were reported (Common Terminology Criteria for Adverse Events version 3.0); 4 complications were early effects and 1 complication was a late effect. All analyses were performed in terms of 5-fraction equivalent dosing. According to our study, D1cc at a dose of 32.9Gy and Dmax dose of 43.4Gy corresponded to a complication probability of 50% for grade 2 toxicity. In this series of 58 CyberKnife mediastinal lung cases, no grade 3 or higher esophageal toxicity occurred. Our estimates of esophageal toxicity are compared with the data in the literature. Further research needs to be performed to establish more reliable dose limits as longer follow-up and toxicity outcomes are reported in patients treated with SBRT for central lung lesions.
authors.affiliation: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. Electronic address: j.nuyttens@erasmusmc.nl.
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Nuyttens
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA.
authors.forename: Vitali
authors.initials: V
authors.lastname: Moiseenko
authors.affiliation: Department of Radiation Oncology, WellStar Kennestone Hospital, Marietta, GA.
authors.forename: Mark
authors.initials: M
authors.lastname: McLaughlin
authors.affiliation: Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, PA.
authors.forename: Sheena
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Radiation Oncology, Abington Memorial Hospital, Abington, PA.
authors.forename: Scott
authors.initials: S
authors.lastname: Herbert
authors.affiliation: Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, PA.
authors.forename: Jimm
authors.initials: J
authors.lastname: Grimm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004941:Esophagitis / Q000209:etiology*; D004947:Esophagus / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011836:Radiation Tolerance; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage