Multivariable normal-tissue complication modeling of acute esophageal toxicity in advanced stage non-small cell lung cancer patients treated with intensity-modulated (chemo-)radiotherapy.

Abstract

BACKGROUND AND PURPOSE:

The majority of normal-tissue complication probability (NTCP) models for acute esophageal toxicity (AET) in advanced stage non-small cell lung cancer (AS-NSCLC) patients treated with (chemo-)radiotherapy are based on three-dimensional conformal radiotherapy (3D-CRT). Due to distinct dosimetric characteristics of intensity-modulated radiation therapy (IMRT), 3D-CRT based models need revision. We established a multivariable NTCP model for AET in 149 AS-NSCLC patients undergoing IMRT.

MATERIALS AND METHODS:

An established model selection procedure was used to develop an NTCP model for Grade ⩾2 AET (53 patients) including clinical and esophageal dose-volume histogram parameters.

RESULTS:

The NTCP model predicted an increased risk of Grade ⩾2 AET in case of: concurrent chemoradiotherapy (CCR) [adjusted odds ratio (OR) 14.08, 95% confidence interval (CI) 4.70-42.19; p<0.001], increasing mean esophageal dose [Dmean; OR 1.12 per Gy increase, 95% CI 1.06-1.19; p<0.001], female patients (OR 3.33, 95% CI 1.36-8.17; p=0.008), and ⩾cT3 (OR 2.7, 95% CI 1.12-6.50; p=0.026). The AUC was 0.82 and the model showed good calibration.

CONCLUSIONS:

A multivariable NTCP model including CCR, Dmean, clinical tumor stage and gender predicts Grade ⩾2 AET after IMRT for AS-NSCLC. Prior to clinical introduction, the model needs validation in an independent patient cohort.

• Authors: Robin Wijsman, Frank Dankers, Esther G C Troost, Aswin L Hoffmann, Erik H F M van der Heijden, Lioe-Fee de Geus-Oei, Johan Bussink
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 117 Issue 1 Pg. 49-54 (Oct 2015) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 26341608 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Topics

• Adult
• Aged
• Carcinoma, Non-Small-Cell Lung (drug therapy, pathology, radiotherapy)
• Chemoradiotherapy
• Cohort Studies
• Esophageal Diseases (etiology)
• Esophagus (radiation effects)
• Female
• Humans
• Lung Neoplasms (drug therapy, pathology, radiotherapy)
• Male
• Middle Aged
• Models, Statistical
• Multivariate Analysis
• Radiation Injuries (etiology)
• Radiometry
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Retrospective Studies