The Impact of Lung and Heart Radiation Dose During Preoperative Chemoradiation on Overall Survival in Esophageal Cancer-A Post Hoc Analysis of CALGB 80803 (Alliance)
Abstract
Purpose: Although technical advances have allowed for reduced radiation doses to the lungs and heart when treating esophageal cancer, doses to these organs cannot yet be eliminated completely. We conducted a post hoc analysis of CALGB 80803 (Alliance) to evaluate whether the radiation doses delivered to the heart and lungs in a prospective study with robust quality assurance were associated with overall survival (OS), and we assessed the impact of intensity modulated radiation therapy (IMRT) on adherence with protocol-specified dose constraints.
Methods and materials: Protocol-specified dose constraints were based on standard of care guidelines: total lung V10 Gy ≤ 40%, V20 Gy ≤ 20%, V30 Gy ≤ 15%, V40 Gy ≤ 10%; heart V30 Gy ≤ 30%. Post hoc dose cutpoints were calculated that best differentiated OS.
Results: A total of 225 patients underwent induction chemotherapy, where radiation modality data were available for 209/225 (92.8%); 127/209 (60.9%) were treated with IMRT. Adherence rates were high for each of the protocol-specified dose constraints: 162/209 (77.5%), 179/209 (85.6%), 207/209 (99.0%), 208/209 (99.5%), and 158/209 (75.6%); total lung: V10 Gy, V20 Gy, V30 Gy, V40 Gy, and heart V30 Gy, respectively. The heart V30 Gy ≤ 21% (P = .016) was associated with improved OS. Among patients with heart V30 Gy ≤ 21%, 8.5% and 32.3% received 3-dimensional conformal radiation therapy (3D-CRT) and IMRT, respectively (P 42% (hazard ratio [HR], 1.71; P = .017) and heart V30 Gy > 21%…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 225 participants or records.
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