Hani Al-Halabi1, Peter Paetzold1, Gregory C Sharp1, Christine Olsen1, Henning Willers2. 1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 2. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: hwillers@mgh.harvard.edu.
Abstract
PURPOSE: Severe (Radiation Therapy Oncology Group [RTOG] grade 3 or greater) esophagitis generally occurs in 15% to 25% of non-small cell lung cancer (NSCLC) patients undergoing concurrent chemotherapy and radiation therapy (CCRT), which may result in treatment breaks that compromise local tumor control and pose a barrier to dose escalation. Here, we report a novel contralateral esophagus-sparing technique (CEST) that uses intensity modulated radiation therapy (IMRT) to reduce the incidence of severe esophagitis. METHODS AND MATERIALS: We reviewed consecutive patients with thoracic malignancies undergoing curative CCRT in whom CEST was used. The esophageal wall contralateral (CE) to the tumor was contoured as an avoidance structure, and IMRT was used to guide a rapid dose falloff gradient beyond the target volume in close proximity to the esophagus. Esophagitis was recorded based on the RTOG acute toxicity grading system. RESULTS: We identified 20 consecutive patients treated with CCRT of at least 63 Gy in whom there was gross tumor within 1 cm of the esophagus. The median radiation dose was 70.2 Gy (range, 63-72.15 Gy). In all patients, ≥99% of the planning and internal target volumes was covered by ≥90% and 100% of prescription dose, respectively. Strikingly, no patient experienced grade ≥3 esophagitis (95% confidence limits, 0%-16%) despite the high total doses delivered. The median maximum dose, V45, and V55 of the CE were 60.7 Gy, 2.1 cc, and 0.4 cc, respectively, indicating effective esophagus cross-section sparing by CEST. CONCLUSION: We report a simple yet effective method to avoid exposing the entire esophagus cross-section to high doses. By using proposed CE dose constraints of V45 <2.5 cc and V55 <0.5 cc, CEST may improve the esophagus toxicity profile in thoracic cancer patients receiving CCRT even at doses above the standard 60- to 63-Gy levels. Prospective testing of CEST is warranted.
PURPOSE: Severe (Radiation Therapy Oncology Group [RTOG] grade 3 or greater) esophagitis generally occurs in 15% to 25% of non-small cell lung cancer (NSCLC) patients undergoing concurrent chemotherapy and radiation therapy (CCRT), which may result in treatment breaks that compromise local tumor control and pose a barrier to dose escalation. Here, we report a novel contralateral esophagus-sparing technique (CEST) that uses intensity modulated radiation therapy (IMRT) to reduce the incidence of severe esophagitis. METHODS AND MATERIALS: We reviewed consecutive patients with thoracic malignancies undergoing curative CCRT in whom CEST was used. The esophageal wall contralateral (CE) to the tumor was contoured as an avoidance structure, and IMRT was used to guide a rapid dose falloff gradient beyond the target volume in close proximity to the esophagus. Esophagitis was recorded based on the RTOG acute toxicity grading system. RESULTS: We identified 20 consecutive patients treated with CCRT of at least 63 Gy in whom there was gross tumor within 1 cm of the esophagus. The median radiation dose was 70.2 Gy (range, 63-72.15 Gy). In all patients, ≥99% of the planning and internal target volumes was covered by ≥90% and 100% of prescription dose, respectively. Strikingly, no patient experienced grade ≥3 esophagitis (95% confidence limits, 0%-16%) despite the high total doses delivered. The median maximum dose, V45, and V55 of the CE were 60.7 Gy, 2.1 cc, and 0.4 cc, respectively, indicating effective esophagus cross-section sparing by CEST. CONCLUSION: We report a simple yet effective method to avoid exposing the entire esophagus cross-section to high doses. By using proposed CE dose constraints of V45 <2.5 cc and V55 <0.5 cc, CEST may improve the esophagus toxicity profile in thoracic cancerpatients receiving CCRT even at doses above the standard 60- to 63-Gy levels. Prospective testing of CEST is warranted.
Authors: Peter Paximadis; Matthew Schipper; Martha Matuszak; Mary Feng; Shruti Jolly; Thomas Boike; Inga Grills; Larry Kestin; Benjamin Movsas; Kent Griffith; Gregory Gustafson; Jean Moran; Teamour Nurushev; Jeffrey Radawski; Lori Pierce; James Hayman Journal: Pract Radiat Oncol Date: 2017-07-19
Authors: Núria Rodríguez De Dios; Arturo Navarro-Martin; Cristina Cigarral; Rodolfo Chicas-Sett; Rafael García; Virginia Garcia; Jose Antonio Gonzalez; Susana Gonzalo; Mauricio Murcia-Mejía; Rogelio Robaina; Amalia Sotoca; Carmen Vallejo; German Valtueña; Felipe Couñago Journal: World J Clin Oncol Date: 2022-04-24
Authors: Li Ma; Bo Qiu; QiWen Li; Li Chen; Bin Wang; YongHong Hu; MengZhong Liu; Li Zhang; Yan Huang; XiaoWu Deng; YunFei Xia; MaoSheng Lin; Hui Liu Journal: Radiat Oncol Date: 2018-07-17 Impact factor: 3.481