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Objectively Quantifying Radiation Esophagitis With Novel Computed Tomography-Based Metrics.

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Area of Science:

  • Radiation oncology
  • Medical imaging
  • Oncologic imaging

Background:

  • Radiation esophagitis is a common side effect of thoracic radiation therapy.
  • Accurate objective measures are needed to assess its severity.
  • Intensity modulated radiation therapy (IMRT) for non-small cell lung cancer (NSCLC) necessitates precise toxicity monitoring.

Purpose of the Study:

  • To evaluate radiation-induced esophageal expansion as an objective biomarker for radiation esophagitis.
  • To correlate esophageal expansion metrics with clinical esophagitis grades in NSCLC patients treated with IMRT.

Main Methods:

  • Weekly CT imaging and esophagitis scoring (CTCAE 4.0) in 85 NSCLC patients undergoing IMRT.
  • Calculation of 19 esophageal expansion metrics using deformable image registration and Jacobian determinants.
  • Application of an anatomic variability correction method to reduce uncertainty in metric calculations.

Main Results:

  • Esophageal expansion significantly increased with higher esophagitis grades (2 and 3).
  • Thirteen of 19 metrics demonstrated high accuracy (AUC > 0.80) in classifying esophagitis.
  • Maximum axial expansion (MaxExp1) and length with axial expansion ≥30% (LenExp30%) showed the highest predictive performance.

Conclusions:

  • Esophageal expansion, particularly MaxExp1 and LenExp30%, serves as a viable objective measure of radiation esophagitis.
  • Specific metric values can predict the probability of developing grade 3 esophagitis.
  • Anatomic correction methods enhance the reliability of Jacobian-based esophageal expansion calculations.