Annals of Oncology Advance Access originally published online on February 23, 2007
Annals of Oncology 2007 18(5):909-916; doi:10.1093/annonc/mdm005
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© 2007 European Society for Medical Oncology
lung cancer |
Maximal neutropenia during chemotherapy and radiotherapy is significantly associated with the development of acute radiation-induced dysphagia in lung cancer patients
1 Department of Radiotherapy, MAASTRO clinic, GROW, University Hospital Maastricht, Maastricht, The Netherlands
2 Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
3 Department of Radiotherapy and Oncology, Jolimont Hospital, La Louvière, Belgium
4 Department of Pulmonology, University Hospital Maastricht, Maastricht
5 Department of Pulmonology, Atrium Medical Centre, Heerlen
6 Department of Pulmonology, Maasland Hospital, Sittard
7 Department of Pulmonology, Laurentius Hospital, Roermond
8 Department of Pulmonology, Sint Jans Hospital, Weert, The Netherlands
* Correspondence to: Dr D. De Ruysscher, Department of Radiotherapy, University Hospital Maastricht, Dr Tanslaan 12, 6229 ET Maastricht, The Netherlands. Tel: +31-88-445-57-00; Fax: +31-88-445-57-73; E-mail: dirk.deruysscher{at}maastro.nl
Background: Acute dysphagia is a distressing dose-limiting toxicity after concurrent chemoradiation or high-dose radiotherapy for lung cancer. We therefore identified factors associated with the occurrence of acute dysphagia in lung cancer patients receiving radiotherapy alone or combined with chemotherapy.
Patients and methods: Radiotherapy, chemotherapy and patient characteristics were analyzed using ordinal regression analysis as possible predictors for acute dysphagia (CTCAE 3.0) in 328 lung cancer patients treated with curative intent.
Results: The most significant association was seen between the maximal grade of neutropenia during chemoradiation and dysphagia, with an odds ratio increasing from 1.49 [95% confidence interval (CI) 0.63–3.54, P = 0.362] for grade 1–2 neutropenia to 19.7 (95% CI 4.66–83.52, P < 0.001) for patients with grade 4 neutropenia. Twice-daily schedule, mean esophageal dose and administration of chemotherapy were significant predictive factors. By combining these factors, a high-performance predictive model was made. On an individual patient level, 64% of patients were correctly classified and only 1.2% of patients were misclassified by more than one grade.
Conclusions: The maximal neutrophil toxicity during concurrent chemotherapy and radiotherapy is strongly associated with the development of acute dysphagia. A multivariate predictive model was developed.
Key words: chemotherapy, esophagitis, lung cancer, neutropenia, predictive factors, radiotherapy
These authors equally contributed to the study. Received for publication September 28, 2006. Revision received December 28, 2006. Accepted for publication January 8, 2007.