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. 2024 Jun 16;12(17):2995-3003.
doi: 10.12998/wjcc.v12.i17.2995.

Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation

Mei-Chen Ji  1 , Zhi-Jia Li  1 , Ke Li  1 , Yun-Xiao Wang  1 , Bo Yang  1 , Lin-Lin Lv  1 , Ying Su  1 , Zhi-Wei Zhang  1 , Zhong-Chao Huo  1 , Qing Qi  2 , Yong-Chang Lu  3 , Zhi-Qiang Cui  4 , Yan-Bao Liu  5
Affiliations

Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation

Mei-Chen Ji et al. World J Clin Cases. .

Abstract

Background: Radiation esophagitis (RE) is one of the most common clinical symptoms of regi-onal lymph node radiotherapy for breast cancer. However, there are fewer studies focusing on RE caused by hypofractionated radiotherapy (HFRT).

Aim: To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes.

Methods: Between January and December 2022, we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F.

Results: Of the 64 patients in this study, 24 (37.5%) did not develop RE, 29 (45.3%) developed grade 1 RE (G1RE), 11 (17.2%) developed grade 2 RE (G2RE), and none developed grade 3 RE or higher. Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose, mean dose, relative volume 20-40, and absolute volume (AV) 20-40. Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE (P < 0.001). The optimal threshold for AV30 was 2.39 mL [area under the curve (AUC): 0.996; sensitivity: 90.9%; specificity: 91.1%]. The optimal threshold for AV35 was 0.71 mL (AUC: 0.932; sensitivity: 90.9%; specificity: 83.9%).

Conclusion: AV30 and AV35 were significantly associated with G2RE. The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL, respectively.

Keywords: Breast cancer; Dosimetric parameters; Esophagitis; Hypofractionated radiotherapy; Radiation esophagitis.

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Conflict of interest statement

Conflict-of-interest statement: Dr. Qi reports grants from the Handan City Science and Technology Research and Development Program.

Figures

Figure 1
Figure 1
The esophageal area from the lower edge of the cricoid cartilage to the lower edge of the aortic arch. A and B: The esophagus is outlined in the front and side view; C: An illustration of the supraclavicular nodal outlined and dose distribution; D: An illustration of the chest wall and axillary nodal outlined and dose distribution after mastectomy; E: An illustration of the breast/tumor bed outlined and dose distribution after breast-conserving surgery. The colors corresponding to the prescription dose from low to high are blue, green, yellow, and red.
Figure 2
Figure 2
Proportion of patients with radiation esophagitis over time. G0: No radiation oesophagitis; G1: Grade 1 radiation oesophagitis; G2: Grade 2 radiation oesophagitis.
See this image and copyright information in PMC

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