High-dose preoperative chemoradiotherapy in esophageal cancer patients does not increase postoperative pulmonary complications: Correlation with dose–volume histogram parameters

Abstract 

Purpose

To investigate the association of high-dose preoperative chemoradiotherapy (CRT) and dose–volume histogram (DVH) parameters of lungs with incidence of postoperative pulmonary complications and to identify predictive clinical factors of pulmonary complications.

Methods

Data of 65 patients were collected retrospectively. Thirty-five patients underwent transthoracic esophagectomy (TTE) alone and 30 received cisplatin and 5-fluorouracil, concomitant with radiotherapy, median dose 66Gy, and followed by TTE. From the DVH for each lung alone and for both lungs together as one organ we generated total lung volume, mean radiotherapy dose, relative and absolute volumes receiving more than a threshold dose, and relative and absolute volumes receiving less than a threshold dose. Postoperative pulmonary complications were defined as pneumonia or respiratory failure.

Results

Sixty percent of the patients in the TTE alone group had postoperative pulmonary complications versus 63% in the CRT+TTE group. Postoperative mortality was 8.6% and 16.7% in the respective patient groups (p=NS). None of the DVH parameters was associated with postoperative pulmonary complications. Squamous cell carcinoma was an adverse factor related to increased postoperative pulmonary complications.

Conclusion

High-dose preoperative CRT was not associated with increased postoperative pulmonary complications in this cohort of esophageal cancer patients.

Keywords: Esophageal neoplasm, Radiotherapy dosage, Pulmonary complications, Dose–volume histogram, Multimodality therapy