Brown Andrea, Hu Chen, Ke Suqi, Han Peijin, Hales Russell, McNutt Todd, Li Siyao, Snyder Claire, Lee Shing, Voong Khinh Ranh
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Adv Radiat Oncol. 2025 May 24;10(8):101807. doi: 10.1016/j.adro.2025.101807. eCollection 2025 Aug.
Chemoradiation for locally advanced non-small cell lung cancer can cause severe esophagitis. Techniques to spare the contralateral esophagus may mitigate toxicity, but traditional dose-volume histograms (DVH) do not capture the degree of circumferential irradiation. We evaluated dose-length histogram (DLH) parameters as predictors of dysphagia compared with DVH metrics.
We retrospectively reviewed patients treated with definitive thoracic radiation therapy from 2019 to 2023. Descriptive statistics described the cohort. Clinician-reported (National Cancer Institute Common Terminology Criteria for Adverse Events [CTCAE] v.4) and patient-reported outcomes (PRO)-CTCAE v.1 dysphagia within 120 days of treatment start were collected prospectively. The McNemar test compared dichotomized scores. The length of esophageal full-circumferential (L) and partial-circumferential irradiation (L) was defined as the length of the esophagus with ≥90% and ≥50% circumference exposure to threshold radiation doses, respectively. Spearman correlation examined relationships between L, L, and volumetric (V) parameters. Associations between L L and V, and grade ≥2 dysphagia were evaluated using univariate logistic regression. Likelihood ratio tests assessed model fit.
Of 107 patients, 86.9% (93) had non-small cell lung cancer, all received ≥60 Gy (median, 63 Gy; range, 60-70 Gy), and 94.4% (101) received concurrent chemotherapy. Patients and physicians reported rates of grade ≥2 dysphagia differently: 17 (15.9%) and 6 (5.6%), respectively ( = .0015). Each 0.5 cm increase in the length of partial-circumference esophagus receiving ≥55 Gy (L) and 60 Gy (L) resulted in increased odds of PRO-CTCAE dysphagia by 8% and 9%, respectively. Each 0.5 cm increase in full-circumference esophagus receiving ≥60 Gy (L) resulted in 11% increased odds of PRO-CTCAE dysphagia. Esophageal DLH parameters, L and L, correlated with the esophageal V volumetric parameter strongly (ρ = 0.751 and 0.729, respectively). No DVH or DLH parameter predicted grade ≥2 CTCAE dysphagia.
Esophageal DLH metrics assessing partial- or full-circumferential esophageal irradiation, specifically L, L, and L, are associated with patient-reported dysphagia and complement traditional DVH parameters.
局部晚期非小细胞肺癌的放化疗可导致严重食管炎。保护对侧食管的技术可能会减轻毒性，但传统的剂量体积直方图（DVH）无法反映环形照射的程度。我们评估了剂量长度直方图（DLH）参数作为吞咽困难预测指标，并与DVH指标进行比较。
我们回顾性分析了2019年至2023年接受确定性胸部放疗的患者。描述性统计描述了该队列。前瞻性收集了临床医生报告的（美国国立癌症研究所不良事件通用术语标准[CTCAE]第4版）和患者报告的结局（PRO）-CTCAE第1版治疗开始后120天内的吞咽困难情况。McNemar检验比较二分法评分。食管全周向（L）和部分周向照射（L）的长度分别定义为食管周长暴露于阈值辐射剂量≥90%和≥50%的长度。Spearman相关性检验研究了L、L和体积（V）参数之间的关系。使用单因素逻辑回归评估L、L和V与≥2级吞咽困难之间的关联。似然比检验评估模型拟合度。
107例患者中，86.9%（93例）患有非小细胞肺癌，均接受了≥60 Gy（中位数，63 Gy；范围，60 - 70 Gy）的放疗，94.4%（101例）接受了同步化疗。患者和医生报告的≥2级吞咽困难发生率不同：分别为17例（15.9%）和6例（5.6%）（P = 0.0015）。接受≥55 Gy（L）和60 Gy（L）的部分周向食管长度每增加0.5 cm，PRO-CTCAE吞咽困难的几率分别增加8%和9%。接受≥60 Gy（L）的全周向食管长度每增加0.5 cm，PRO-CTCAE吞咽困难的几率增加11%。食管DLH参数L和L与食管V体积参数高度相关（分别为ρ = 0.751和0.729）。没有DVH或DLH参数能够预测≥2级CTCAE吞咽困难。
评估部分或全周向食管照射的食管DLH指标，特别是L、L和L，与患者报告的吞咽困难相关，并可补充传统的DVH参数。
