Dosimetric and clinical predictors for radiation esophagitis in patients with breast cancer undergoing conventional fractionated regional nodal irradiation: A prospective study
This study aimed to determine dosimetric and clinical predictors of radiation esophagitis (RE) in breast cancer patients undergoing conventional fractionated regional nodal irradiation (RNI). Eligible patients received radiotherapy (RT; 50 Gy in 25 fractions) to the chest wall, supraclavicular/infraclavicular fossa, level II axilla, and/or internal mammary chain. RE was graded weekly during RT and at weeks 1, 2 and months 3, 6 post-RT (CTCAE v3.0). The esophagus was contoured from the lower edge of cricoid cartilage to aortic arch. Esophageal parameters included mean dose (Dmean), maximum dose (Dmax), relative (RV5-RV45) and absolute volumes (AV5-AV45) receiving 5-45 Gy in 5-Gy increments. Univariate and multivariate analyses identified predictors of grade ≥2 RE. Among 541 prospectively enrolled patients (minimum 6 months follow-up), 271 (50.1%) had left-sided breast cancer. Grade 2 RE was 23.7% (128/541), with no grade ≥3 RE. Tumor laterality (p < .001) was the only clinical risk factor. Esophageal Dmean, Dmax, RV20-RV40, and AV20-AV35 were dosimetric parameters of grade ≥2 RE in univariate analysis. Multivariate analysis identified RV30 <9% (13.9% vs. 31.3%) and AV30 <1 mL (15.2% vs. 30.5%) as optimal dosimetric predictors. Therefore, RE is common in patients receiving RNI, with tumor laterality being the clinical risk factor. Limiting upper esophagus RV30 <9% and AV30 <1 mL may reduce RE risk.
Authors
- Yufei Lu (ORCID: https://orcid.org/0000-0002-7054-8421)
- Dan‐Qiong Wang
- Xiaorong Hou (ORCID: https://orcid.org/0000-0001-8217-8491)
- Hui Fang
- Lina Zhao (ORCID: https://orcid.org/0000-0002-1053-6824)
- Ning Han (ORCID: https://orcid.org/0000-0003-4362-7906)
- Ye‐Xiong Li (ORCID: https://orcid.org/0000-0003-0985-235X)
- Hao Jing
- Wenlei Yang (ORCID: https://orcid.org/0000-0001-9065-649X)
- Dongxing Shen
- Shulian Wang (ORCID: https://orcid.org/0000-0001-7322-9621)
- Yu Tang (ORCID: https://orcid.org/0000-0002-9221-6591)
- Qiuzi Zhong (ORCID: https://orcid.org/0000-0001-8569-8214)
- Jun Zhang (ORCID: https://orcid.org/0000-0002-4540-5314)
- Xiaohong Wang (ORCID: https://orcid.org/0000-0001-8465-9782)
- Jian Tie (ORCID: https://orcid.org/0000-0002-1136-1536)
- Yirui Zhai
- Jun Ma
- Xiaoli Yu (ORCID: https://orcid.org/0000-0002-9315-5663)
- Yahua Zhong
- Na Zhang (ORCID: https://orcid.org/0000-0001-5775-5357)
Institutions
- Hebei Medical University (CN)
- Nanjing University of Chinese Medicine (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Peking University (CN)
- Wenzhou Medical University (CN)
- Peking Union Medical College Hospital (CN)
- Wuhan University (CN)
- Zhengzhou University (CN)
- Fudan University Shanghai Cancer Center (CN)
- Peking University Cancer Hospital (CN)
- Tangshan People's Hospital (CN)
- Fourth Hospital of Hebei Medical University (CN)
- Beijing Hospital (CN)
- Zhongnan Hospital of Wuhan University (CN)
- Henan Cancer Hospital (CN)
- Ministry of Education (ET)
- Jiangsu Province Hospital (CN)
- Zhejiang Taizhou Hospital (CN)
- Xijing Hospital (CN)
- Hubei Cancer Hospital (CN)
- Liaoning Cancer Hospital & Institute (CN)
- Taizhou University (CN)
- Air Force Medical University (CN)
Publication Details
- Journal
- International Journal of Cancer
- Published
- 2025-09-18
- DOI
- https://doi.org/10.1002/ijc.70161
- Primary Topic
- Breast Cancer Treatment Studies
- Type
- article
- Field-Weighted Citation Impact
- 0.00