XXXX after preoperative chemoradiation for @entity418 : correlation with pulmonary dose-volume histogram parameters.

@entity1 @entity55 @entity5 @entity649 @entity260 @entity3907 @entity6500 @entity358 @entity418
PURPOSE: To clarify the relationship between the percentage of lung receiving low radiation doses with concurrent chemotherapy and the occurrence of @entity260 in the treatment of @entity418 . METHODS: From 117 @entity1 who underwent preoperative chemoradiation for esophageal @entity5 at our institution between 1998 and 2002, we selected 61 @entity1 for whom complete pulmonary dose-volume histogram (DVH) data were available and analyzed the incidence of @entity55 and @entity649 ( @entity649 ) in this group. All @entity1 received concurrent chemoradiation therapy, and 39 @entity1 also received induction chemotherapy before concurrent chemoradiation. The median age was 62 years, and the median radiotherapy dose was 45 Gy. The percentage of lung volume receiving at least 10 Gy (V10), 15 Gy ( @entity6500 ), and 20 Gy (V20) were recorded from each pulmonary DVH. RESULTS: Eleven (18%) of the 61 @entity1 had @entity358 , 2 of whom died after progression of @entity55 . Pulmonary complications were noted more often (35% vs. 8%, p = 0.014) when the pulmonary V10 was > or =40% vs. <40% and when the @entity6500 was > or /=30% vs. < 30% (33% vs. 10%, p = 0.036). An apparent increase in @entity358 rate when V20 was > or =20% vs. <20% (32% vs. 10%, p = 0.079) was not significant. None of the other factors analyzed (surgical procedure, @entity5 location, use of induction chemotherapy, use of concurrent @entity3907 -based chemoradiation, or smoking history) was associated with the occurrence of @entity358 . The median hospital stay was 17 days for @entity1 who had @entity358 vs. 12 days for @entity1 who did not (p = 0.08). CONCLUSIONS: The use of multimodality therapy may require minimization of lung volume irradiation to levels lower than previously expected. Radiotherapy techniques that decrease the volume of lung receiving low radiation doses may significantly reduce the risk of this potentially life-threatening complication.
