Kevin L Stephans1, Toufik Djemil2, Claudiu Diaconu3, Chandana A Reddy2, Ping Xia2, Neil M Woody2, John Greskovich2, Vinit Makkar4, Gregory M M Videtic2. 1. Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio. Electronic address: stephak@ccf.org. 2. Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio. 3. Cleveland Clinic Learner College of Medicine, Cleveland, Ohio. 4. Department of Medical Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio.
Abstract
PURPOSE: To identify factors associated with grade ≥3 treatment related late esophageal toxicity after lung or liver stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS: This was a retrospective review of 52 patients with a planning target volume within 2 cm of the esophagus from a prospective registry of 607 lung and liver SBRT patients treated between 2005 and 2011. Patients were treated using a risk-adapted dose regimen to a median dose of 50 Gy in 5 fractions (range, 37.5-60 Gy in 3-10 fractions). Normal structures were contoured using Radiation Therapy Oncology Group (RTOG) defined criteria. RESULTS: The median esophageal point dose and 1-cc dose were 32.3 Gy (range, 8.9-55.4 Gy) and 24.0 Gy (range, 7.8-50.9 Gy), respectively. Two patients had an esophageal fistula at a median of 8.4 months after SBRT, with maximum esophageal point doses of 51.5 and 52 Gy, and 1-cc doses of 48.1 and 50 Gy, respectively. These point and 1-cc doses were exceeded by 9 and 2 patients, respectively, without a fistula. The risk of a fistula for point doses exceeding 40, 45, and 50 Gy was 9.5% (n=2/21), 10.5% (n=2/19), and 12.5% (n=2/16), respectively. The risk of fistula for 1-cc doses exceeding 40, 45, and 50 Gy was 25% (n=2/9), 50% (n=2/4), and 50% (n=2/4), respectively. Eighteen patients received systemic therapy after SBRT (11 systemic chemotherapy, and 6 biologic agents, and 1 both). Both patients with fistulas had received adjuvant anti-angiogenic (vascular endothelial growth factor) agents within 2 months of completing SBRT. No patient had a fistula in the absence of adjuvant VEGF-modulating agents. CONCLUSIONS: Esophageal fistula is a rare complication of SBRT. In this series, fistula was seen with esophageal point doses exceeding 51 Gy and 1-cc doses greater than 48 Gy. Notably, however, fistula was seen only in those patients who also received adjuvant VEGF-modulating agents after SBRT. The potential interaction of dose and adjuvant therapy should be considered when delivering SBRT near the esophagus.
PURPOSE: To identify factors associated with grade ≥3 treatment related late esophageal toxicity after lung or liver stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS: This was a retrospective review of 52 patients with a planning target volume within 2 cm of the esophagus from a prospective registry of 607 lung and liver SBRTpatients treated between 2005 and 2011. Patients were treated using a risk-adapted dose regimen to a median dose of 50 Gy in 5 fractions (range, 37.5-60 Gy in 3-10 fractions). Normal structures were contoured using Radiation Therapy Oncology Group (RTOG) defined criteria. RESULTS: The median esophageal point dose and 1-cc dose were 32.3 Gy (range, 8.9-55.4 Gy) and 24.0 Gy (range, 7.8-50.9 Gy), respectively. Two patients had an esophageal fistula at a median of 8.4 months after SBRT, with maximum esophageal point doses of 51.5 and 52 Gy, and 1-cc doses of 48.1 and 50 Gy, respectively. These point and 1-cc doses were exceeded by 9 and 2 patients, respectively, without a fistula. The risk of a fistula for point doses exceeding 40, 45, and 50 Gy was 9.5% (n=2/21), 10.5% (n=2/19), and 12.5% (n=2/16), respectively. The risk of fistula for 1-cc doses exceeding 40, 45, and 50 Gy was 25% (n=2/9), 50% (n=2/4), and 50% (n=2/4), respectively. Eighteen patients received systemic therapy after SBRT (11 systemic chemotherapy, and 6 biologic agents, and 1 both). Both patients with fistulas had received adjuvant anti-angiogenic (vascular endothelial growth factor) agents within 2 months of completing SBRT. No patient had a fistula in the absence of adjuvant VEGF-modulating agents. CONCLUSIONS:Esophageal fistula is a rare complication of SBRT. In this series, fistula was seen with esophageal point doses exceeding 51 Gy and 1-cc doses greater than 48 Gy. Notably, however, fistula was seen only in those patients who also received adjuvant VEGF-modulating agents after SBRT. The potential interaction of dose and adjuvant therapy should be considered when delivering SBRT near the esophagus.
Authors: S Adebahr; S Collette; E Shash; M Lambrecht; C Le Pechoux; C Faivre-Finn; D De Ruysscher; H Peulen; J Belderbos; R Dziadziuszko; C Fink; M Guckenberger; C Hurkmans; U Nestle Journal: Br J Radiol Date: 2015-04-15 Impact factor: 3.039
Authors: Erqi L Pollom; Lei Deng; Reetesh K Pai; J Martin Brown; Amato Giaccia; Billy W Loo; David B Shultz; Quynh Thu Le; Albert C Koong; Daniel T Chang Journal: Int J Radiat Oncol Biol Phys Date: 2015-07-01 Impact factor: 7.038
Authors: Ping Xia; Rupesh Kotecha; Naveen Sharma; Martin Andrews; Kevin L Stephans; Carlos Oberti; Sara Lin; Oussama Wazni; Patrick Tchou; Walid I Saliba; John Suh Journal: Cureus Date: 2016-07-11
Authors: Oliver Blanck; Svenja Ipsen; Mark K Chan; Ralf Bauer; Matthias Kerl; Peter Hunold; Volkmar Jacobi; Ralf Bruder; Achim Schweikard; Dirk Rades; Thomas J Vogl; Peter Kleine; Frank Bode; Jürgen Dunst Journal: Cureus Date: 2016-07-20
Authors: Theresa Voglhuber; Kerstin A Eitz; Markus Oechsner; Marco M E Vogel; Stephanie E Combs Journal: BMC Cancer Date: 2021-07-06 Impact factor: 4.430
Authors: Aadel A Chaudhuri; Jie Jane Chen; Justin N Carter; Michael S Binkley; Kiran A Kumar; Sara A Dudley; Arthur W Sung; Billy W Loo Journal: Cureus Date: 2016-04-19