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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2009

01-06-2009 | Thoracic Oncology

Association of Clinical and Dosimetric Factors with Postoperative Pulmonary Complications in Esophageal Cancer Patients Receiving Intensity-Modulated Radiation Therapy and Concurrent Chemotherapy Followed by Thoracic Esophagectomy

Authors: Feng-Ming Hsu, MD, Yung-Chie Lee, MD, PhD, Jang-Ming Lee, MD, PhD, Chih-Hung Hsu, MD, PhD, Chia-Chi Lin, MD, PhD, Yu-Chieh Tsai, MD, Jian-Kuen Wu, MS, Jason Chia-Hsien Cheng, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2009

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Abstract

Background

To investigate the association between clinical/dosimetric factors and postoperative pulmonary complications (PPC) in esophageal cancer patients undergoing neoadjuvant chemotherapy and intensity-modulated radiation therapy (IMRT) followed by thoracic esophagectomy.

Methods

The data from 52 patients receiving combined modality treatment were analyzed. Chemotherapy was taxane-based in 43 and 5-fluorouracil-based in 9 patients. IMRT (40–45 Gy, median 40 Gy, at 1.8–2 Gy per fraction) was given using a 3–5-beam arrangement. Surgery consisted of open or minimally invasive esophagectomy. The dosimetric parameters were generated from lung dose-volume histogram computed by the treatment planning software. PPC was defined as pneumonia or respiratory insufficiency within 30 days after surgery. Statistical correlations were analyzed between clinical/dosimetric factors and PPC.

Results

The incidence of PPC was 34.6%. No patients died of PPC. Two patients (3.8%) became ventilator dependent. In univariate analyses, preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity before surgery were significantly associated with PPC (P = 0.02 and 0.04, respectively). None of the dosimetric factors predicted development of PPC. For the 51 patients undergoing right transthoracic surgery, higher absolute spared volume of the right lung receiving 15 Gy was significantly associated with PPC (P = 0.03). In multivariate analysis, preoperative FEV1 was the only independent factor associated with PPC (P = 0.002).

Conclusions

Preoperative rather than prechemoradiation FEV1 predicts development of PPC. Reducing the absolute volume of the right lung that is irradiated might decrease the risk of PPC for patients receiving right transthoracic surgery.
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Metadata
Title
Association of Clinical and Dosimetric Factors with Postoperative Pulmonary Complications in Esophageal Cancer Patients Receiving Intensity-Modulated Radiation Therapy and Concurrent Chemotherapy Followed by Thoracic Esophagectomy
Authors
Feng-Ming Hsu, MD
Yung-Chie Lee, MD, PhD
Jang-Ming Lee, MD, PhD
Chih-Hung Hsu, MD, PhD
Chia-Chi Lin, MD, PhD
Yu-Chieh Tsai, MD
Jian-Kuen Wu, MS
Jason Chia-Hsien Cheng, MD, PhD
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0401-0

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