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Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT

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Abstract

Purpose

Multimodality therapy for esophageal cancer can cause various kinds of treatment-related sequelae, especially pulmonary toxicities. This prospective study aims to investigate the clinical and dosimetric parameters predicting lung injury in patients undergoing radiation therapy for esophageal cancer.

Methods

Forty-five esophageal cancer patients were prospectively analyzed. The pulmonary toxicities (or sequelae) were evaluated by comparing chest X-ray films, pulmonary function tests and symptoms caused by pulmonary damage before and after treatment. All patients were treated with either three-dimensional radiotherapy (3DCRT) or with intensity-modulated radiotherapy (IMRT). The planning dose volume histogram was used to compute the lung volumes receiving more than 5, 10, 20 and 30 Gy (V5, V10, V20, V30) and mean lung dose.

Results

V20 was larger in the IMRT group than in the 3DCRT group (p = 0.002). V20 (>15%) and V30 (>20%) resulted in a statistically significant increase in the occurrence of chronic pneumonitis (p = 0.03) and acute pneumonitis (p = 0.007), respectively.

Conclusions

The study signifies that a larger volume of lung receives lower doses because of multiple beam arrangement and a smaller volume of lung receives higher doses because of better dose conformity in IMRT plans. Acute pneumonitis correlates more with V30 values, whereas chronic pneumonitis was predominantly seen in patients with higher V20 values.

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Acknowledgments

All the authors are in debt to our seniors who helped us in preparing this work. We all acknowledge our patients for their understanding and cooperation.

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Authors and Affiliations

  1. Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085, India

    Gaurav Kumar, Sheh Rawat, Abhishek Puri & Manoj Kumar Sharma

  2. Department of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, 110085, India

    Anand Giri Babu & Girigesh Yadav

  3. Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India

    Pranav Chadha

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  1. Gaurav Kumar
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  2. Sheh Rawat
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Correspondence to Gaurav Kumar.

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Kumar, G., Rawat, S., Puri, A. et al. Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT. Jpn J Radiol 30, 18–24 (2012). https://doi.org/10.1007/s11604-011-0002-2

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  • DOI: https://doi.org/10.1007/s11604-011-0002-2

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