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Radiation Oncology
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Esophageal Cancer | Research

Prognostic significance of lung radiation dose in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy

Authors: Jhen-Bin Lin, Li-Chung Hung, Ching-Yuan Cheng, Yu-An Chien, Chou-Hsien Lee, Chia-Chun Huang, Tsai-Wei Chou, Ming-Huei Ko, Yuan-Chun Lai, Mu-Tai Liu, Tung-Hao Chang, Jie Lee, Yu-Jen Chen

Published in: Radiation Oncology | Issue 1/2019

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Abstract

Background

The prognostic significance of radiation dose to the lung or heart is unknown in esophageal cancer patients receiving neoadjuvant chemoradiotherapy followed by surgery (trimodal therapy). This study aimed to determine the association between lung and heart radiation dose volumes and prognosis of esophageal cancer after trimodal therapy.

Methods

This study reviewed 123 esophageal cancer patients treated with trimodal therapy in two tertiary institutions between 2010 and 2015. The dose-volume histogram parameter of Vx was defined as the percentage of total organ volume receiving a radiation dose of x (Gy) or more. Predictors of overall survival (OS) were identified using Cox regression models. Receiver-operating characteristic curves were used to select cut-off values for dose-volume.

Results

Median follow-up was 28.3 months (range: 4.7–92.8 months). Median OS and progression-free survival were 34.0 months (95% confidence interval [CI]: 27.4–40.6 months) and 24.8 months (95% CI, 18.9–30.7 months), respectively. Multivariate analyses showed that lung V20 (hazard ratio, 1.09; 95% CI: 1.04–1.14; p < 0.001) and lung V5 (hazard ratio, 1.02; 95% CI: 1.00–1.05; p = 0.03) were associated with OS when adjusting for surgical margin and pathological treatment response. The 5-year OS for patients with lung V20 ≤ 23% vs. patients with lung V20 > 23% was 54.4% vs. 5% (p < 0.001) whereas that for patients with lung V5 ≤ 56% vs. patients with lung V5 > 56% was 81.5% vs. 23.4% (p < 0.001). Mean heart dose showed no association with survival outcomes.

Conclusions

Lung radiation dose was independently associated with survival outcomes in esophageal cancer patients treated with neoadjuvant chemoradiotherapy and surgery.
Appendix
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Metadata
Title
Prognostic significance of lung radiation dose in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy
Authors
Jhen-Bin Lin
Li-Chung Hung
Ching-Yuan Cheng
Yu-An Chien
Chou-Hsien Lee
Chia-Chun Huang
Tsai-Wei Chou
Ming-Huei Ko
Yuan-Chun Lai
Mu-Tai Liu
Tung-Hao Chang
Jie Lee
Yu-Jen Chen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1283-3

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