Abstract
Dose-volume parameters are needed to guide the safe administration of stereotactic ablative radiotherapy (SABR). We report on esophageal tolerance to high-dose hypofractionated radiation in patients treated with SABR. Thirty-one patients with spine or lung tumors received single- or multiple-fraction SABR to targets less than 1cm from the esophagus. End points evaluated include D5cc (minimum dose in Gy to 5cm3 of the esophagus receiving the highest dose), D2cc, D1cc, and Dmax (maximum dose to 0.01cm3). Multiple-fraction treatments were correlated using the linear quadratic and linear quadratic-linear/universal survival models. Three esophageal toxicity events occurred, including esophagitis (grade 2), tracheoesophageal fistula (grade 4-5), and esophageal perforation (grade 4-5). Chemotherapy was a cofactor in the high-grade events. The median time to development of esophageal toxicity was 4.1months (range 0.6-6.1months). Two of the three events occurred below a published D5cc threshold, all three were below a D2cc threshold, and one was below a Dmax threshold. We report a dosimetric analysis of incidental dose to the esophagus from SABR. High-dose hypofractionated radiotherapy led to a number of high-grade esophageal adverse events, suggesting that conservative parameters to protect the esophagus are necessary when SABR is used, especially in the setting of chemotherapy or prior radiotherapy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 623-629 |
| Number of pages | 7 |
| Journal | Diseases of the Esophagus |
| Volume | 25 |
| Issue number | 7 |
| DOIs | |
| State | Published - Sep 2012 |
| Externally published | Yes |
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Keywords
- Esophagus
- Hypofractionation
- Stereotactic ablative radiotherapy
- Stereotactic body radiotherapy
- Toxicity
ASJC Scopus subject areas
- Gastroenterology
Cite this
Esophageal tolerance to high-dose stereotactic ablative radiotherapy. / Abelson, J. A.; Murphy, J. D.; Loo, B. W.; Chang, D. T.; Daly, Megan E; Wiegner, E. A.; Hancock, S.; Chang, S. D.; Le, Q. T.; Soltys, S. G.; Gibbs, I. C.
In: Diseases of the Esophagus, Vol. 25, No. 7, 09.2012, p. 623-629.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Esophageal tolerance to high-dose stereotactic ablative radiotherapy
AU - Abelson, J. A.
AU - Murphy, J. D.
AU - Loo, B. W.
AU - Chang, D. T.
AU - Daly, Megan E
AU - Wiegner, E. A.
AU - Hancock, S.
AU - Chang, S. D.
AU - Le, Q. T.
AU - Soltys, S. G.
AU - Gibbs, I. C.
PY - 2012/9
Y1 - 2012/9
N2 - Dose-volume parameters are needed to guide the safe administration of stereotactic ablative radiotherapy (SABR). We report on esophageal tolerance to high-dose hypofractionated radiation in patients treated with SABR. Thirty-one patients with spine or lung tumors received single- or multiple-fraction SABR to targets less than 1cm from the esophagus. End points evaluated include D5cc (minimum dose in Gy to 5cm3 of the esophagus receiving the highest dose), D2cc, D1cc, and Dmax (maximum dose to 0.01cm3). Multiple-fraction treatments were correlated using the linear quadratic and linear quadratic-linear/universal survival models. Three esophageal toxicity events occurred, including esophagitis (grade 2), tracheoesophageal fistula (grade 4-5), and esophageal perforation (grade 4-5). Chemotherapy was a cofactor in the high-grade events. The median time to development of esophageal toxicity was 4.1months (range 0.6-6.1months). Two of the three events occurred below a published D5cc threshold, all three were below a D2cc threshold, and one was below a Dmax threshold. We report a dosimetric analysis of incidental dose to the esophagus from SABR. High-dose hypofractionated radiotherapy led to a number of high-grade esophageal adverse events, suggesting that conservative parameters to protect the esophagus are necessary when SABR is used, especially in the setting of chemotherapy or prior radiotherapy.
AB - Dose-volume parameters are needed to guide the safe administration of stereotactic ablative radiotherapy (SABR). We report on esophageal tolerance to high-dose hypofractionated radiation in patients treated with SABR. Thirty-one patients with spine or lung tumors received single- or multiple-fraction SABR to targets less than 1cm from the esophagus. End points evaluated include D5cc (minimum dose in Gy to 5cm3 of the esophagus receiving the highest dose), D2cc, D1cc, and Dmax (maximum dose to 0.01cm3). Multiple-fraction treatments were correlated using the linear quadratic and linear quadratic-linear/universal survival models. Three esophageal toxicity events occurred, including esophagitis (grade 2), tracheoesophageal fistula (grade 4-5), and esophageal perforation (grade 4-5). Chemotherapy was a cofactor in the high-grade events. The median time to development of esophageal toxicity was 4.1months (range 0.6-6.1months). Two of the three events occurred below a published D5cc threshold, all three were below a D2cc threshold, and one was below a Dmax threshold. We report a dosimetric analysis of incidental dose to the esophagus from SABR. High-dose hypofractionated radiotherapy led to a number of high-grade esophageal adverse events, suggesting that conservative parameters to protect the esophagus are necessary when SABR is used, especially in the setting of chemotherapy or prior radiotherapy.
KW - Esophagus
KW - Hypofractionation
KW - Stereotactic ablative radiotherapy
KW - Stereotactic body radiotherapy
KW - Toxicity
UR - http://www.scopus.com/inward/record.url?scp=84866292846&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866292846&partnerID=8YFLogxK
U2 - 10.1111/j.1442-2050.2011.01295.x
DO - 10.1111/j.1442-2050.2011.01295.x
M3 - Article
C2 - 22168251
AN - SCOPUS:84866292846
VL - 25
SP - 623
EP - 629
JO - Diseases of the Esophagus
JF - Diseases of the Esophagus
SN - 1120-8694
IS - 7
ER -