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Radiation Pneumonitis after Intensity-Modulated Radiotherapy for Esophageal Cancer: Institutional Data and a

J J Tonison1, S G Fischer1, M Viehrig1

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Radiation pneumonitis (RP) incidence is low after esophageal cancer radiochemotherapy using intensity modulated radiotherapy (IMRT). Higher lung V20 correlates with increased RP risk, necessitating caution in patients with lung conditions.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Clinical Oncology

Background:

  • Thoracic radiotherapy can lead to radiation pneumonitis (RP), a significant complication.
  • Esophageal cancer treatment often involves radiochemotherapy, raising concerns about RP incidence.

Purpose of the Study:

  • To determine the incidence of radiation pneumonitis (RP) following radiochemotherapy with intensity modulated radiotherapy (IMRT) for esophageal cancer.
  • To correlate RP occurrence with dose volume histogram (DVH) parameters, specifically lung V20.
  • To review existing literature on RP after IMRT for esophageal cancer.

Main Methods:

  • Retrospective analysis of 73 patients treated with IMRT for esophageal cancer.
  • Extraction of lung irradiation doses from radiotherapy treatment plans.
  • Systematic literature review of PubMed for studies on RP after IMRT in esophageal cancer.

Main Results:

  • Institutional cohort: 5.5% incidence of Grade II or higher RP.
  • Systematic review (874 patients): 6.6% incidence of Grade II or higher RP.
  • No Grade IV or V RP reported in the literature.
  • Increased RP incidence associated with higher lung V20 values.

Conclusions:

  • Radiochemotherapy with IMRT for esophageal cancer demonstrates a low incidence of symptomatic RP.
  • Maintaining lung V20 below 23% is recommended to minimize RP risk.
  • Extra caution is advised for patients with pre-existing lung conditions.