Radiotherapy Dose to Lung Affects Overall Survival Among Patients With Esophageal Cancer
Researchers evaluated the outcomes of 453 patients with stage I to III esophageal cancer who received definitive or preoperative chemoradiation.
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A large chemoradiation dose to the lung is a significant independent predictor for survival among patients with esophageal cancer, according to an abstract being presented at the 2018 Gastrointestinal Cancers Symposium in San Francisco, California.1
For this study, researchers evaluated the outcomes of 453 patients with stage I to III esophageal cancer who received definitive or preoperative chemoradiation. Nearly 98% of patients received intensity modulated radiation therapy, and researchers reviewed the dose-volume histogram (DVH) metrics for the heart (max and mean dose, V5Gy, V10Gy, V20Gy, V30Gy, and V40Gy) and lung (mean dose, V5Gy and V20Gy). Other clinical factors, such as surgery, performance status, histology, and stage, were assessed.
The mean follow-up was 28.4 months. Significant associations were observed between older age, not having undergone surgery, worse performance status, stage III disease, heart V40Gy, lung V5Gy, lung V20Gy, and decreased survival.
Further analysis with multivariate regression revealed, however, that while lung V20Gy (P = .0389), surgery (P = .008), and stage III disease (P < .0002) continued to be significant factors affecting survival, a large heart dose of V40Gy was not. Patients with V20Gy less than 20% had a median survival of 44.0 months compared with 24.0 months among patients with lung V20Gy 20% and greater.
The authors concluded that “esophageal cancer outcomes may be improved by minimizing lung dose, particularly the volume receiving 20Gy or more, and provides further rationale for pursuing new techniques to reduce lung dose, such as proton therapy.”
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- Oh P, Zhang M, Brady P, et al. Impact of lung and heart dose on survival after radiotherapy for esophageal cancer. Oral presentation at: 2018 Gastrointestinal Cancers Symposium; January 18-20, 2018; San Francisco, CA.