Prospective Observational Study on Esophagitis in Breast Cancer Patients with Supraclavicular Nodal Irradiation - A Common Predicament

Background: The present study aimed to assess the dosimetric parameters that may be associated with oesophagitis in patients with breast cancer undergoing three-dimensional radiotherapy. Methods: A single-arm study was conducted on 25 breast cancer patients. Enrolled patients received 40.05Gy in 15 fractions to the chest wall and supraclavicular nodes with 3DCRT. Toxicity grading was examined once a week to assess the onset of grade 2 esophagitis in respective patients. Analyzed parameters incorporate mean oesophageal dose and maximum doses to the esophagus, esophagus volume, and oesophageal length within the supraclavicular nodal PTV treatment area. Results: The mean age was 43.48 years and Grade 2 oesophagitis was noted in 13 of the 25 patients (52%). The onset of oesophagitis was significantly associated with the oesophageal length associated with the treating area (p= 0.04). The laterality of disease did not show a significant relation (p=0.93). For the commencement of grade 2 oesophagitis, odds ratios were 2.33 (95% CI=1.1-3.89, p=0.02) for a mean esophageal dose ≥12Gy and 2.5 (95% CI=1.2-5.18, p=0.04) for ≥ 4.5 cm of esophagus length within supraclavicular nodal PTV area. Conclusion: In patients receiving radiation to the supraclavicular area, the mean oesophageal radiation dose and oesophageal length included in the treatment area correlate with the development of acute oesophagitis, which can be minimized by reducing those two parameters.