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Treatment-related esophagitis.
1Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19107, USA. maria.werner-wasik@mail.tju.edu
Seminars in Oncology
|July 15, 2005
Summary
Concurrent chemoradiotherapy for lung cancer significantly increases esophagitis risk. Amifostine, a radioprotectant, did not reduce severe esophagitis but improved swallowing dysfunction over time in a randomized trial.
Area of Science:
- Oncology
- Radiation Therapy
- Medical Physics
Background:
- Lung cancer treatment intensification aims to improve survival through dose-intense chemotherapy and radiation therapy (RT).
- Concurrent chemoradiotherapy (chemoRT) for lung cancer increases the risk of severe acute esophagitis compared to RT alone.
- Esophagitis is a dose-limiting toxicity that can negatively impact tumor control and patient survival.
Purpose of the Study:
- To evaluate the efficacy of amifostine as a radioprotectant in reducing esophagitis during chemoRT for locally advanced non-small cell lung cancer.
- To assess the impact of amifostine on severe esophagitis and patient-reported swallowing dysfunction.
Main Methods:
- A large phase III, randomized study (RTOG 98-01) involving 243 patients with locally advanced non-small cell lung cancer.
- Patients received concurrent chemoradiotherapy with or without amifostine.
- Esophagitis severity was assessed using National Cancer Institute Common Toxicity Criteria and physician dysphagia logs; patient-reported swallowing dysfunction was measured using diaries.
Main Results:
- Amifostine did not significantly reduce severe esophagitis based on standard clinical assessments.
- Swallowing dysfunction over time, as measured by patient diaries (Esophagitis Index), was significantly lower in the amifostine arm (P = .03).
Conclusions:
- Amifostine may offer a benefit in mitigating long-term swallowing dysfunction associated with chemoRT for lung cancer.
- Further research is needed to identify effective strategies for minimizing or eliminating esophagitis in lung cancer patients undergoing thoracic radiation therapy.