Symptomatic esophagitis in breast cancer regional nodal irradiation: Dose-volume predictors
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Published on: February 6, 2019
Osman Burak Can1, Burcu Durmak İşman1, Mehmet Emin Arayıcı2
1Department of Radiation Oncology, Acibadem Kent Hospital, İzmir, Türkiye.
Purpose:
This study aimed to determine esophageal dose-volume parameters predictive of radiation-induced symptomatic esophagitis (RISE) in patients with breast cancer undergoing regional nodal irradiation (RNI).
Materials And Methods:
We retrospectively analyzed 246 patients (median age, 51 years; range, 25-84), all of whom received adjuvant RNI. Radiotherapy was delivered to the regional nodes with a median dose of 50 Gy (range, 45 Gy-50 Gy) in 25 fractions. Esophageal dose-volume parameters, including V5-V45Gy (absolute volume in cc), Dmax, and the mean dose of the esophagus along the supraclavicular planning target volume (Dmean), were derived from dose-volume histograms. RISE was assessed in accordance with CTCAE v5.0. ROC curve analysis was performed to evaluate the predictive power of each parameter and define optimal cut-off values.
Results:
RISE was observed in 40 of 246 patients (16.3%). All esophageal dose-volume parameters (V5-V45Gy, Dmax, and Dmean) were significantly higher in the RISE group ( P < 0.001). V25Gy and V35Gy were the most predictive parameters for RISE, with AUC values of 0.790 and 0.788, respectively. The risk of RISE was 2.4% vs. 30.1% for V25Gy < 0.75 cc vs. ≥ 0.75 cc ( P < 0.001), and 4.2% vs. 32.7% for V35Gy < 0.38 cc vs. ≥ 0.38 cc ( P < 0.001).
Conclusion:
Maintaining esophageal dose-volume parameters below the identified thresholds (V25Gy < 0.75 cc and V35Gy < 0.38 cc) may substantially reduce the risk of RISE in patients with breast cancer undergoing RNI with a 25-fraction schedule.