Chad Tang1, Zhongxing Liao1, Yan Zhuang1, Lawrence B Levy1, Chun Hung2, Xiaodong Li3, Shane P Krafft4, Mary K Martel4, Ritsuko Komaki1, Daniel R Gomez5. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 2. Chinese Medical University Hospital, Taichung, Taiwan. 3. Department of Oncology, The 3rd Hospital of Jinan, Shandong, China. 4. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: dgomez@mdanderson.org.
Abstract
BACKGROUND AND PURPOSE: Radiation esophagitis (RE) represents an inflammatory reaction to radiation therapy (RT). We hypothesized that aspects of the physiologic acute phase response (APR) predicts RE. MATERIAL AND METHODS: We retrospectively analyzed 285 patients with non-small cell lung cancer (NSCLC) treated with definitive radiation. The primary analysis was the association of pretreatment lab values reflective of the APR with symptomatic (grade ⩾ 2) RE. Univariate and multivariate odds ratios (ORs) were calculated to test associations of clinical and pretreatment lab values with RE. Optimal cutpoints and multivariable risk stratification groupings were determined via recursive partitioning analysis. RESULTS: Pretreatment platelet counts were higher and hemoglobin levels lower in patients who developed RE (P<0.05). Based on these two pre-treatment risk factors, an APR score was defined as 0 (no risk factors), 1 (either risk factor), or 2 (both risk factors). APR score was significantly associated with RE in both univariate (OR = 2.3 for each point, 95% confidence interval [CI] 1.5-3.4, P = 0.001) and multivariate (OR = 2.1, 95% CI 1.3-3.4, P = 0.002) analyses. CONCLUSIONS: The APR score may represent a novel metric to predict RE. However, pending validation in an independent dataset, caution is advised when interpreting these results given their retrospective and thus exploratory nature.
BACKGROUND AND PURPOSE:Radiation esophagitis (RE) represents an inflammatory reaction to radiation therapy (RT). We hypothesized that aspects of the physiologic acute phase response (APR) predicts RE. MATERIAL AND METHODS: We retrospectively analyzed 285 patients with non-small cell lung cancer (NSCLC) treated with definitive radiation. The primary analysis was the association of pretreatment lab values reflective of the APR with symptomatic (grade ⩾ 2) RE. Univariate and multivariate odds ratios (ORs) were calculated to test associations of clinical and pretreatment lab values with RE. Optimal cutpoints and multivariable risk stratification groupings were determined via recursive partitioning analysis. RESULTS: Pretreatment platelet counts were higher and hemoglobin levels lower in patients who developed RE (P<0.05). Based on these two pre-treatment risk factors, an APR score was defined as 0 (no risk factors), 1 (either risk factor), or 2 (both risk factors). APR score was significantly associated with RE in both univariate (OR = 2.3 for each point, 95% confidence interval [CI] 1.5-3.4, P = 0.001) and multivariate (OR = 2.1, 95% CI 1.3-3.4, P = 0.002) analyses. CONCLUSIONS: The APR score may represent a novel metric to predict RE. However, pending validation in an independent dataset, caution is advised when interpreting these results given their retrospective and thus exploratory nature.
Authors: Shulian Wang; Jeff Campbell; Matthew H Stenmark; Paul Stanton; Jing Zhao; Martha M Matuszak; Randall K Ten Haken; Feng-Ming Kong Journal: Radiother Oncol Date: 2018-03 Impact factor: 6.280