Dose-volumetric parameters and prediction of severe acute esophagitis in patients with locally-advanced non small-cell lung cancer treated with neoadjuvant concurrent hyperfractionated-accelerated chemoradiotherapy

Background: To identify dose-volume parameters predictive for
severity of acute esophagitis (CTC > grade 2) in
locally-advanced non small-cell lung cancer (LA-NSCLC) patients
treated with neoadjuvant concurrent hyperfractionated-accelerated
chemoradiotherapy (HA-CRT) a retrospective analysis was performed.
88 patients were treated with HA-CRT followed by radical surgery.
Predictive power of absolute oesophageal length, absolute and
relative oesophageal volume included in the 95\%-isodose,
patient-and tumor-related factors for severity of acute esophagitis
was assessed. Findings: A total of 82 patients (93\%) developed
radiation-induced acute esophagitis. Grade 1 was documented in 1
(1\%), grade 2 in 55 (67\%), grade 3 in 23 (28\%) and grade 4 in 3
(4\%) patients, respectively. Absolute oesophageal volume included
in the 95\%-isodose (42.8 Gy) achieved 13.5 cm(3) (range: 3 - 29
cm(3)). Of the tested variables in univariate analysis, absolute
oesophageal volume included in the 95\%-Isodose was found to be the
only significant variable (p = 0.03) predicting severe acute
esophagitis (CTC > grade 2). For this volume a gradation scale
of the likelihood of severity was built. Conclusion: Increase of
absolute oesophageal volume included in the 95\%-isodose correlates
with severity of acute esophagitis in LA-NSCLC patients treated
with neo-adjuvant concurrent HA-CRT.