The esophageal dose-volume parameters for predicting Grade I-II acute esophagitis correlated with weight loss and serum albumin decrease in lung cancer radiotherapy.

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Date: Jan-March 2021
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 3,632 words
Lexile Measure: 1630L

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Byline: Zumrut. Kaymak Cerkesli, Emine. Ozkan, Alper. Ozseven

Introduction: Acute esophagitis (AE) is a commonly encountered side effect of curative thoracic radiotherapy (CTRT) for lung cancer patients. Nevertheless, its identification for widely used scoring systems depends on patients' statements. It is aimed to evaluate the correlation between the esophagus doses during CTRT and Grade 1-2 AE, weight change, and change in serum albumin (Alb) levels. Subjects and Methods: The data collected from 124 lung cancer patients treated with [greater-than or equal to]60 Gy CTRT were evaluated retrospectively. Weight and serum Alb level difference of each patient, throughout CTRT, were calculated. The percentage of the esophagus volume receiving [greater-than or equal to]5 Gy (V5), V10, V35, V50, and V60; the absolute esophagus volume receiving [greater-than or equal to]60 Gy (V60(cc)); the length of esophagus receiving [greater-than or equal to]60 Gy (L60); the average esophagus dose (D[sub]mean); and the maximum esophagus dose (D[sub]max) were the dose parameters calculated. The correlations were performed by Spearman's rank correlation coefficient. Results: Grade 1 and Grade 2 AE were reported in 62 and 25 patients, respectively. All of the dose parameters were correlated with Grade 1-2 AE (P < 0.001) and weight loss (P < 0.001 for all, except D[sub]max P = 0.018). Decrease in serum Alb level was significantly correlated with all the parameters, but V5 and V10. Receiver operating characteristic curve analysis was performed for five parameters with the highest correlation coefficient (V35, V50, V60(%), V60(cc), and D[sub]mean), and the cutoff values were 39.5%, 28.17%, 2.21%, 0.5cc, and 26.04 Gy, respectively. Conclusions: The correlation of the dose parameters that might be effective on Grade 1-2 AE with the weight loss and Alb loss was investigated, and the cutoff values corresponding to the best sensitivity and specificity were identified.


Lung cancer has the highest incidence rate and is one of the main causes of cancer-related death worldwide and most patients present in advanced stage.[1] Curative thoracic radiotherapy (CTRT) is the standard treatment for limited staged small-cell lung cancer (SCLC) and Stage III non-small cell lung cancer (NSCLC).[2] In addition, CTRT is a treatment option for Stage I-II NSCLC patients who are medically inoperable or refused surgery.[3]

Esophagus is a critical organ of dose constraints in thoracic definitive radiotherapy (RT) for lung cancer, especially in patients with mediastinal lymph node involvement.[4],[5] Characteristic clinical features of acute esophagitis (AE) are substernal pain, odynophagia, and dysphagia, typically occurring 2-3 weeks after beginning of RT and relieving 2-3 weeks after completion of treatment.[6] 0%-26% of patients treated with CTRT may suffer from severe AE requiring IV therapy, hyperalimentation, or causing weight loss.[7] With concurrent chemoradiotherapy (CCRT) or hyperfractionation, severe AE rate increases to 15%-25%.[8],[9],[10]

The most commonly used scoring systems for AE are Radiation Therapy Oncology Group (RTOG)-Radiotherapy Acute Morbidity Criteria scale and National Cancer Institute-Common Toxicity Criteria scale.[11],[12] Grade 1 is defined as mild symptomatic and Grade 2 is defined as moderately symptomatic in both scoring systems. The definition of Grade 3 in RTOG scale includes 15%...

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Gale Document Number: GALE|A655948417