Multivariable normal-tissue complication modeling of acute esophageal toxicity in advanced stage non-small cell lung cancer patients treated with intensity-modulated (chemo-)radiotherapy. Issue 1 (October 2015)

• Record Type: Journal Article
• Authors: Wijsman, Robin; Dankers, Frank; Troost, Esther G.C.; Hoffmann, Aswin L.; van der Heijden, Erik H.F.M.; de Geus-Oei, Lioe-Fee; Bussink, Johan
• Is Part Of: Radiotherapy and oncology. Volume 117:Issue 1(2015:Oct.)
• Page Start: 49
• Page End: 54
• Publication Date: 2015-10
• Subjects: Non-small cell lung cancer -- Esophagitis -- Intensity-modulated radiation therapy -- Predictive models; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.08.010
• Languages: English
• ISSNs: 0167-8140

Abstract

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 [ D mean ; 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, D mean, 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.