Prospective cohort study to validate esophageal dose constraints and predictive models for esophagitis in patients with breast cancer undergoing hypofractionated regional nodal radiotherapy

IF 5.3 1区 医学 Q1 ONCOLOGY
Dan-Qiong Wang , Lei Yan , Hong-Fen Wu , Ya-Hua Zhong , Xiao-Bo Huang , Jing Jin , Qiu-Zi Zhong , Li-Na Zhao , Xiao-Hong Wang , Hao Jing , Yu Tang , Yong-Wen Song , Ning-Ning Lu , Bo Chen , Yue-Ping Liu , Shu-Nan Qi , Yuan Tang , Yi-Rui Zhai , Wen-Wen Zhang , Ning Li , Shu-Lian Wang
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引用次数: 0

Abstract

Purpose

Esophageal RV25 < 20 % and AV35 < 0.27 mL were reported as dose constraints predictive of grade ≥ 2 radiation esophagitis (RE) for breast cancer in our previous study. This prospective study aimed to validate the effectiveness of esophageal dose constraints and develop RE prediction models.

Methods

We enrolled 465 patients with breast cancer receiving 43.5 Gy in 15 fractions to the chest wall and nodal regions using IMRT/VMAT between January 2022 and February 2024. The esophagus was contoured from the cricoid cartilage level to the aortic arch’s lower margin. RE was assessed weekly during radiotherapy and at weeks 1 and 2 and months 3 and 6 post-RT using CTCAE v3.0. Analyzed esophageal dosimetric parameters: total volume, mean/max dose, the relative and absolute volumes receiving at least 5–45 Gy by 5 Gy increments (RV5–RV45 and AV5–AV45). Predictive models incorporating tumor laterality, internal mammary nodal irradiation (IMNI), and RV25 or AV35 thresholds were developed. Discrimination (AUC) and calibration [Hosmer-Lemeshow (H-L) test] were evaluated, and risk stratification was performed using decision tree analysis.

Results

The grade 2 RE incidence (23.7 %) was considerably lower than in a previous report (40.9 %), and no grade ≥ 3 RE was observed. Both models performed well (RV25 model: AUC, 0.688, H-L, p = 0.974; AV35 model: AUC, 0.651, H-L, p = 0.776). Risk factors for RE included left-side tumor, IMNI, and RV25 ≥ 20 % or AV35 ≥ 0.27 mL. Patients with no risk factors were classified as low risk, those with one risk factor as intermediate risk, and those with ≥ 2 risk factors as high risk. The grade ≥ 2 RE incidence differed significantly across groups (RV25: 14.8 % vs. 24.7 % vs. 48.3 %; AV35: 14.7 % vs. 23.7 % vs. 45.4 %).

Conclusion

Clinical validation confirmed the effectiveness of esophageal dose constraints and the predictive accuracy of the RV25 and AV35 models. Avoiding unnecessary IMNI and maintaining RV25 < 20 % and AV35 < 0.27 mL could reduce the risk for RE.
前瞻性队列研究以验证接受低分割区域淋巴结放疗的乳腺癌患者食管炎的剂量限制和预测模型。
方法:我们招募了465例乳腺癌患者,在2022年1月至2024年2月期间,使用IMRT/VMAT对胸壁和淋巴结区进行15次43.5 Gy的放疗。从环状软骨水平到主动脉弓下缘的食道轮廓。放疗期间每周评估一次RE,放疗后第1、2周和第3、6个月使用CTCAE v3.0评估。分析食道剂量学参数:总容积、平均/最大剂量、接受至少5-45 Gy 5 Gy增量的相对容积和绝对容积(RV5-RV45和AV5-AV45)。建立了结合肿瘤侧边性、乳腺内淋巴结照射(IMNI)和RV25或AV35阈值的预测模型。评估鉴别(AUC)和校准[Hosmer-Lemeshow (H-L)检验],并采用决策树分析进行风险分层。结果:2级RE发生率(23.7 %)明显低于先前报道(40.9 %),未观察到 ≥ 3级RE。两种模型均表现良好(RV25模型AUC, 0.688, H-L, p = 0.974;AV35模型AUC, 0.651, H-L, p = 0.776)。RE的危险因素包括左侧肿瘤、IMNI和RV25 ≥ 20 %或AV35 ≥ 0.27 mL。无危险因素者为低危,有1个危险因素者为中危,有 ≥ 2个危险因素者为高危。 ≥ 2级RE发生率组间差异显著(RV25: 14.8 % vs. 24.7 % vs. 48.3 %;AV35: 14.7 % vs. 23.7 % vs. 45.4 %)。结论:临床验证了食道剂量限制的有效性和RV25和AV35模型的预测准确性。避免不必要的IMNI,维护RV25
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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