International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationDose–Volume Histogram Parameters and Clinical Factors Associated With Pleural Effusion After Chemoradiotherapy in Esophageal Cancer Patients
Introduction
The prognosis in patients with esophageal cancer has been poor. Surgical resection is a potentially curative treatment for esophageal cancer. However, the mortality is high, and patients are often inoperable because of advanced tumor presentation at diagnosis, cardiopulmonary complications, or poor performance status (1). Radiotherapy (RT) alone was performed for inoperable esophageal cancer, but the 5-year survival rate was less than 10% (2). During the past decade, definitive chemoradiotherapy (CRT) has been considered a curative treatment option and has improved the prognosis for esophageal cancer, with 5-year survival of 26–46% 3, 4, 5, 6.
Chemoradiotherapy has been considered a tolerable treatment as compared to surgical resection, even for patients who had poor performance status or cardiopulmonary complications. As the number of long-term survivors treated with CRT is increasing, treatment-related toxicities have recently been reported, such as radiation pneumonitis, heart failure, pericardial effusion, myocardial infarction, and pleural effusion (7). These late toxicities significantly impair patients' quality of life. Radiation pneumonitis and pericardial effusion have been analyzed to identify risk factors using dose–volume histogram (DVH) parameters in esophageal cancer 8, 9. Pleural effusion often occurs in esophageal cancer after CRT. Most pleural effusion is asymptomatic, whereas a few patients develop symptomatic pleural effusion that requires medical treatment, such as diuretics, thoracentesis, and pleurodesis. However, little has been known about the effect of CRT on pleural effusion in esophageal cancer. Furthermore, to our knowledge there have been no reports to investigate the relationship between DVH parameters and pleural effusion.
Therefore, in this study, we evaluated pleural effusion in esophageal cancer patients treated with concurrent CRT. The DVH parameters and clinical factors were analyzed in relation to pleural effusion.
Section snippets
Patient population
The institutional review board of our hospital approved this analysis. Esophageal cancer patients treated with definitive CRT between January 2001 and March 2007 at Gunma Prefectural Cancer Center were reviewed retrospectively on the basis of the following criteria: pathologically confirmed esophageal cancer, available computed tomography (CT) scan for treatment planning, 6-month follow-up after CRT, and radiation dose ≥50 Gy. Exclusion criteria were lung metastasis, malignant pleural effusion,
Results
Forty-three patients (39 males and 4 females) were enrolled with median follow-up of 27 months after CRT (range, 6–70 months). The median age was 64 years (range, 40–80 years). The Eastern Cooperative Oncology Group performance status of 0, 1, and 2 were 6, 32, and 5 patients, respectively. Squamous cell carcinoma was observed in 40 patients, adenocarcinoma in 2, and basaloid carcinoma in 1. The numbers of patients with Stage I, II, III, IVa, and IVb disease were 9, 7, 16, 3, and 8,
Discussion
We showed the incidence of pleural effusion and the risk factors in esophageal cancer patients treated with concurrent CRT. Although this was a retrospective study, patients were treated with a homogeneous CRT regimen involving nedaplatin and 5-fluorouracil, with a median follow-up of 27 months. Table 3 shows the rate of pleural effusion by several studies of esophageal cancer patients treated with definitive CRT 7, 13, 14. In these studies, Grade 2 or worse pleural effusion was 9–19%, and
Conclusions
Our results suggest that Heart-V50 is a useful DVH parameter as a risk factor for pleural effusion in esophageal cancer patients treated with CRT. The heart should be delineated and be reduced to avoid pleural effusion during radiation treatment planning.
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2017, Computational Statistics and Data AnalysisBayesian regression analyses of radiation modality effects on pericardial and pleural effusion and survival in esophageal cancer
2016, Radiotherapy and OncologyCitation Excerpt :The V5 (0.50 vs. 0.55, P = 0.006) and V10 (0.34 vs. 0.41, P < 0.001) of the lung were significantly lower for the IMRT group than those for 3DCRT group but no differences were seen for V15 and V20 (Supplementary Table 5). IMRT has been shown to reduce radiation dose to adjacent organs compared to 3DCRT in numerous dosimetric studies [7,8,11,12,18], but how this translates to clinical benefit for esophageal cancer patients, especially the risk of developing PCE and PE, has been largely unknown. In the present study, our results showed that IMRT decreased the incidence and postponed the median onset times of PCE and PE, and increased the survival probability of PCE or death and PE or death compared to 3DCRT.
Is cardiac toxicity a relevant issue in the radiation treatment of esophageal cancer?
2015, Radiotherapy and OncologyCitation Excerpt :The strongest prognostic factor was a V30 pericardium of >46%. Shirai et al. retrospectively analyzed 43 esophageal cancer patients [7]. In total, 35% of the patients developed non-malignant PE, including 4 patients (13%) with grade ⩾2, which required medical intervention.
Conflict of interest: none.