Prognostic Significance of Lung Radiation Dose in Patients with Esophageal Cancer Treated with Neoadjuvant Chemoradiotherapy

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2019 May 26

PMID 31126307

Citations 10

Authors

Jhen-Bin Lin

Li-Chung Hung

Ching-Yuan Cheng

Yu-An Chien

Chou-Hsien Lee

Chia-Chun Huang

Tsai-Wei Chou

Ming-Huei Ko

Yuan-Chun Lai

Mu-Tai Liu

Tung-Hao Chang

Jie Lee

Yu-Jen Chen

Affiliations

Soon will be listed here.

Abstract

Background: The prognostic significance of radiation dose to the lung or heart is unknown in esophageal cancer patients receiving neoadjuvant chemoradiotherapy followed by surgery (trimodal therapy). This study aimed to determine the association between lung and heart radiation dose volumes and prognosis of esophageal cancer after trimodal therapy.

Methods: This study reviewed 123 esophageal cancer patients treated with trimodal therapy in two tertiary institutions between 2010 and 2015. The dose-volume histogram parameter of Vx was defined as the percentage of total organ volume receiving a radiation dose of x (Gy) or more. Predictors of overall survival (OS) were identified using Cox regression models. Receiver-operating characteristic curves were used to select cut-off values for dose-volume.

Results: Median follow-up was 28.3 months (range: 4.7-92.8 months). Median OS and progression-free survival were 34.0 months (95% confidence interval [CI]: 27.4-40.6 months) and 24.8 months (95% CI, 18.9-30.7 months), respectively. Multivariate analyses showed that lung V20 (hazard ratio, 1.09; 95% CI: 1.04-1.14; p < 0.001) and lung V5 (hazard ratio, 1.02; 95% CI: 1.00-1.05; p = 0.03) were associated with OS when adjusting for surgical margin and pathological treatment response. The 5-year OS for patients with lung V20 ≤ 23% vs. patients with lung V20 > 23% was 54.4% vs. 5% (p < 0.001) whereas that for patients with lung V5 ≤ 56% vs. patients with lung V5 > 56% was 81.5% vs. 23.4% (p < 0.001). Mean heart dose showed no association with survival outcomes.

Conclusions: Lung radiation dose was independently associated with survival outcomes in esophageal cancer patients treated with neoadjuvant chemoradiotherapy and surgery.

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