Iranian Journal of Medical Physics

Iranian Journal of Medical Physics

Radiobiological Modeling of Acute Esophagitis Following Radiotherapy of Thorax and Head-Neck Tumors: A Comparison of Lyman Kutcher Burman with Equivalent Uniform Dose-Based Models

Document Type : Original Paper

Authors
Mostafa alizade-harakiyan 1
Amir Ghasemi Jangjoo 2
Behnam Nasiri 3
Tohid Jafari-Koshki 4
Murat Okutan 5
Asghar Mesbahi 6
1 Molecular Medicine Research Center, Institute of Bio-medicine, Tabriz University of Medical Sciences, Tabriz, Iran
2 Radiology and Radiotherapy Department, Medical School, Tabriz University of Medical Science, Tabriz, Iran
3 Radiation Oncology Department, Tabriz Vali-asr Hospital, Tabriz, Iran
4 Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
5 Department of Medical Physics, Radiation Oncology Institute, Istanbul University, Istanbul, Turkey.
6 Tabriz University of Medical Sciences
10.22038/ijmp.2019.40500.1566
Abstract
Introduction: The current study aimed to compare the performance of radiobiological models in predicting acute esophagitis (AE) complications after three-dimensional conformal radiation therapy (3D-CRT).
Material and Methods: Out of a total of 100 patients, 50 patients with concurrent chemotherapy and 50 patients without such therapy were treated with different total doses and a daily dose range of 1.8-2.4 Gy on the basis of 5 days a week for 3 months. Predictions of AE were based on Lyman–Kutcher–Burman (LKB) and equivalent uniform dose (EUD)-based radiobiological models. Consequently, 3 months of follow-upwere performed to monitor the complication incidence among the studied patients. Receiver operating characteristic (ROC) and univariable logistic regression analyses were carried out to determine the effect of mean dose, volume percentage, and weight loss percentage on the probability of AE grade ³ 2.
Results: The EUD-basedmodel showed a better concordance with the clinical data for all patients (area under the curve [AUC]=0.919) and the concurrent chemoradiotherapy (CCRT) group (AUC=0.986). For the radiation therapy group, the LKB model had a better performance than the EUD-based model (AUC=0.921). Grade ³ 2 esophagitis occurred 37.94±4.0 and 68.39±7.1 days after the initiation of radiation therapy in the chemoradiation and radiation therapy groups, respectively.
Conclusion: The EUD-basedmodel showed a higher agreement with the follow-up data. The incidence time of grade ³ 2 AE in the CCRT was approximately two times shorter than that in the non-CCRT group.
Keywords
Radiation Therapy
Acute Esophagitis
Modeling
Complications
Concurrent Chemotherapy
Subjects

  1. References

     

    1. Mirinezhad SK, Somi MH, Shirmohamadi M, Seyednejad F, Jangjoo AG, Ghojazadeh M, et al. Impact of Postoperative Chemoradiotherapy and Chemoradiotherapy Alone for Esophageal Cancer in North-West Iran. Asian Pacific J Cancer Prev. 2013;14(6):3921–4.
    2. Mirinezhad SK, Jangjoo AG, Seyednejad F, Naseri AR, Mohammadzadeh M, Nasiri B, et al. Impact of tumor length on survival for patients with resected esophageal cancer. Asian Pac J Cancer Prev. 2014;15(2):691–4.
    3. Pour NH, Farajollahi A, Jamali M, Zeinali A, Jangjou AG. Comparison of three and four-field radiotherapy techniques and the effect of laryngeal shield on vocal and spinal cord radiation dose in radiotherapy of non-laryngeal head and neck tumors. Polish J Med Phys Eng. 2018;24(1):25–31.
    4. Namdar A, Mohammadzadeh M, Okutan M M a. A review on the dosimetrical and radiobiological prediction of radiation-induced hypothyroidism in radiation therapy of head-and-neck cancer, breast cancer, and Hodgkin’s lymphoma survivors. Polish Journal of Medical Physics and Engineering The Journal of Polish Society of Medical Physics. 2018; 137–48.
    5. Mesbahi A, , Rasouli N. Mohammadzadeh M, Nasiri Motlagh B, Ozan Tekin H. Comparison of Radiobiological Models for Radiation Therapy Plans of Prostate Cancer: Three-dimensional Conformal versus Intensity Modulated Radiation Therapy. J Biomed Phys Eng. 2018;8(3):1-2.
    6. Yu Y, Guan H, Dong Y, Xing L, Li X. Advances in dosimetry and biological predictors of radiation-induced esophagitis. Onco Targets Ther. 2016;9:597–603.
    7. Yusung Kim WT. Optimization of Radiotherapy Using Biological Parameters. Clin Evid (Online). 2008;c:253–74.
    8. Mirinezhad SK, Somi MH, Seyednezhad F, Jangjoo AG, Ghojazadeh M, Mohammadzadeh M, et al. Survival in patients treated with definitive chemo- radiotherapy for non-metastatic esophageal cancer in north- west iran. Asian Pac J Cancer Prev. 2013;14(3):1677–80.
    9. Mirinezhad SK, Somi MH, Jangjoo AG, Seyednezhad F, Dastgiri S, Mohammadzadeh M, et al. Survival rate and prognostic factors of esophageal cancer in east Azerbaijan province, North-west of Iran. Asian Pac J Cancer Prev. 2012;13(7):3451–4.
    10. Mesbahi A, Oladghaffari M. An Overview on the Clinical Application of Radiobiological Modeling in Radiation Therapy of Cancer. Int J Radiol Radiat Ther. 2017;2(1):1–0.
    11. Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB. Radiation Dose-Volume Effects in the Esophagus. Int J Radiat Oncol Biol Phys. 2010;76(3 SUPPL.):86–93.
    12. Pan Y, Brink C, Knap M, Khalil AA, Nyhus CH, McCulloch T, et al. Acute esophagitis for patients with local-regional advanced non small cell lung cancer treated with concurrent chemoradiotherapy. Radiother Oncol. 2016;118(3):465–70.
    13. Wijsman R, Dankers F, Troost EGC, Hoffmann AL, Van Der Heijden EHFM, De Geus-Oei LF, et al. Multivariable normal-tissue complication modeling of acute esophageal toxicity in advanced stage non-small cell lung cancer patients treated with intensity-modulated (chemo-)radiotherapy. Radiother Oncol. 2015;117(1):49–54.
    14. Eileen M. Harder, Zhe (Jay) Chen, Henry S. Park, Brandon R. Mancini RHD. Dose-Volume Predictors of Esophagitis after Thoracic Stereotactic Body Radiation Therapy. Am J Clin Oncol Cancer Clin Trials. 2017;40(5):477–82.
    15. Gomez DR, Tucker SL, Martel MK, Mohan R, Balter PA, Guerra JLL, et al. Predictors of high-grade esophagitis after definitive three-dimensional conformal therapy, intensity-modulated radiation therapy, or proton beam therapy for non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2012;84(4):1010–6.
    16. Alevronta E, Ahlberg A, Mavroidis P, Al-Abany M, Friesland S, Tilikidis A, et al. Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy. Radiother Oncol. 2010;97(1):54–9.
    17. Zhu J, Zhang ZC, Li BS, Liu M, Yin Y, Yu JM, et al. Analysis of acute radiation-induced esophagitis in non-small-cell lung cancer patients using the Lyman NTCP model. Radiother Oncol. 2010;97(3):449–54.
    18. Chapet o, Kong f, Lee j, Hayman j H r. Normal tissue complication probability modeling for acute esophagitis in patients treated with conformal radiation therapy for non-small cell lung cancer. Radiother Oncol. 2005;77(2):176–81.
    19. Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, et al. Use of Normal Tissue Complication Probability Models in the Clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 SUPPL.).
    20. Wu AJ, Williams E, Modh A, Foster A, Yorke E, Rimner A, et al. Dosimetric predictors of esophageal toxicity after stereotactic body radiotherapy for central lung tumors. Radiother Oncol. 2014;112(2):267–71.
    21. Bradley J, Deasy JO, Bentzen S, El Naqa I. Dosimetric correlates for acute esophagitis in patients treated with radiotherapy for lung carcinoma. Int J Radiat Oncol Biol Phys. 2004;58(4):1106–13.
    22. UZAN j N a. Radiobiologically guided optimisation of the prescription dose and fractionation scheme in radiotherapy using BioSuite. Br J Radiol. 2012;85(1017):1279–86.
    23. Gay HA, Niemierko A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Phys Medica. 2007;23(3–4):115–25.
    24. Zehentmayr F, Söhn M, Exeli AK, Wurstbauer K, Tröller A, Deutschmann H, et al. Normal tissue complication models for clinically relevant acute esophagitis (≥ grade 2) in patients treated with dose differentiated accelerated radiotherapy (DART-bid). Vol. 10, Radiation Oncology. 2015.
    25. Huang EX, Bradley JD, El Naqa I, Hope AJ, Lindsay PE, Bosch WR, et al. Modeling the risk of radiation-induced acute esophagitis for combined Washington University and RTOG trial 93-11 lung cancer patients. Int J Radiat Oncol Biol Phys. 2012;82(5):1674–9.
    26. Mavroidis P, Laurell G, Kraepelien T, Fernberg JO, Lind BK, Brahme A. Determination and Clinical Verification of Dose-Response Parameters for Esophageal Stricture from Head and Neck Radiotherapy. Acta Oncol (Madr). 2003;42(8):865–81.
    27. Belderbos J, Heemsbergen W, Hoogeman M, Pengel K, Rossi M, Lebesque J. Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy. Radiother Oncol. 2005;75(2):157–64.
    28. Tae HK, Kwan HC, Hong RP, Jin SL, Ji YH, Jae IZ, et al. Dose-volumetric parameters of acute esophageal toxicity in patients with lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2005;62(4):995–1002.
    29. Caglar HB, Othus M, Allen AM. Esophagus in-field: A new predictor for esophagitis. Radiother Oncol. 2010 Oct 1;97(1):48–53.

     

Iranian Journal of Medical Physics
Volume 17, Issue 4 - Serial Number 4
July and August 2020
Pages 225-234

  • Receive Date 20 May 2019
  • Revise Date 23 July 2019
  • Accept Date 01 August 2019