Abstract
Purpose: With dose escalation and increasing use of concurrent chemoradiotherapy, radiation
esophagitis (RE) remains a common treatment-limiting acute side effect in the treatment
of thoracic malignancies. The advent of 3DCT planning has enabled investigators to
study esophageal dose–volume histogram (DVH) parameters as predictors of RE. The purpose
of this study was to assess published dosimetric parameters and toxicity data systematically
in order to define reproducible predictors of RE, both for potential clinical use,
and to provide recommendations for future research in the field. Materials and methods: We performed a systematic literature review of published studies addressing RE in
the treatment of lung cancer and thymoma. Our search strategy included a variety of
electronic medical databases, textbooks and bibliographies. Both prospective and retrospective
clinical studies were included. Information relating to the relationship among measured
dosimetric parameters, patient demographics, tumor characteristics, chemotherapy and
RE was extracted and analyzed. Results: Eighteen published studies were suitable for analysis. Eleven of these assessed acute
RE, while the remainder assessed both acute and chronic RE together. Heterogeneity
of esophageal contouring practices, individual differences in information reporting
and variability of RE outcome definitions were assessed. Well-described clinical and
logistic modeling directly related V35Gy, V60Gy and SA55Gy to clinically significant RE. Conclusions: Several reproducible dosimetric parameters exist in the literature, and these may
be potentially relevant in the prediction of RE in the radiotherapy of thoracic malignancies.
Further clarification of the predictive relationship between such standardized dosimetric
parameters and observed RE outcomes is essential to develop efficient radiation treatment
planning in locally advanced NSCLC in the modern concurrent chemotherapy and image-guided
IMRT era.
Keywords
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Article info
Publication history
Published online: October 24, 2008
Accepted:
September 12,
2008
Received in revised form:
September 8,
2008
Received:
April 2,
2008
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
