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Predicting Radiation-Induced Esophagitis in Locally Advanced NSCLC Using Baseline Clinical Factors: A Model From the
Yuji Uehara1, Kageaki Watanabe2, Jun Tamura3
1Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan; Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan.
Background:
Radiation-induced esophagitis (RE) is common during thoracic radiotherapy for NSCLC. We assessed its clinical impact and developed a model to predict grade ≥ 2 acute RE in patients with unresectable stage III NSCLC undergoing concurrent chemoradiotherapy, using the Japan Lung Cancer Society integrated phase II-III database.
Methods:
We retrospectively analyzed clinical and laboratory data from 1288 patients across 8 randomized trials (1999-2016). We evaluated associations between RE and survival outcomes and identified predictors of grade ≥ 2 acute RE using LASSO regression.
Results:
Grade 2 RE occurred in 15% and grade 3 in 2.0%. Grade ≥ 2 RE was not significantly associated with progression-free survival (PFS; HR 0.98, 95% confidence interval [CI] 0.72-1.34) or overall survival (OS; HR 1.20, 95% CI 0.82-1.75). Grade ≥ 3 RE was significantly associated with worse PFS (HR 1.62, 95% CI 1.12-2.35) but not with OS (HR 1.22, 95% CI 0.58-2.60). Eight variables independently predicted grade ≥ 2 RE: female sex, T stage < 4, N3 status, adenocarcinoma histology, primary tumor in the left upper lobe, cisplatin use, white-blood-cell count < 11 × 109/L, and hemoglobin ≤ 12 g/dL. The model achieved a c-statistic of 0.85 (95% CI, 0.81-0.88).
Conclusion:
In this national clinical-trial cohort, grade ≥ 2 RE was not associated with worse OS, but grade ≥ 3 RE was associated with worse PFS in patients receiving concurrent chemoradiotherapy for unresectable stage III NSCLC. The 8-variable model provides a practical tool for predicting grade ≥ 2 RE and may facilitate tailored supportive care.
