Esophageal tolerance to high-dose stereotactic ablative radiotherapy

J. A. Abelson, J. D. Murphy, B. W. Loo, D. T. Chang, Megan E Daly, E. A. Wiegner, S. Hancock, S. D. Chang, Q. T. Le, S. G. Soltys, I. C. Gibbs

Research output: Contribution to journalArticle

28 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)623-629
Number of pages7
JournalDiseases of the Esophagus
Volume25
Issue number7
DOIs
StatePublished - Sep 2012
Externally publishedYes

Fingerprint

Radiotherapy
Esophagus
Esophageal Perforation
Tracheoesophageal Fistula
Drug Therapy
Esophagitis
Spine
Radiation
Lung
Survival
Neoplasms
Dose Hypofractionation

Keywords

  • Esophagus
  • Hypofractionation
  • Stereotactic ablative radiotherapy
  • Stereotactic body radiotherapy
  • Toxicity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Abelson, J. A., Murphy, J. D., Loo, B. W., Chang, D. T., Daly, M. E., Wiegner, E. A., ... Gibbs, I. C. (2012). Esophageal tolerance to high-dose stereotactic ablative radiotherapy. Diseases of the Esophagus, 25(7), 623-629. https://doi.org/10.1111/j.1442-2050.2011.01295.x

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 journalArticle

Abelson, JA, Murphy, JD, Loo, BW, Chang, DT, Daly, ME, Wiegner, EA, Hancock, S, Chang, SD, Le, QT, Soltys, SG & Gibbs, IC 2012, 'Esophageal tolerance to high-dose stereotactic ablative radiotherapy', Diseases of the Esophagus, vol. 25, no. 7, pp. 623-629. https://doi.org/10.1111/j.1442-2050.2011.01295.x
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. / Esophageal tolerance to high-dose stereotactic ablative radiotherapy. In: Diseases of the Esophagus. 2012 ; Vol. 25, No. 7. pp. 623-629.
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