Annals of Oncology Advance Access published online on February 23, 2007
Annals of Oncology, doi:10.1093/annonc/mdm005
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© 2007 European Society for Medical Oncology
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.
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.