Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation
Mei-Chen Ji, Zhi-Jia Li, Ke Li, Yun-Xiao Wang, Bo Yang, Lin-Lin Lv, Ying Su, Zhi-Wei Zhang, Zhong-Chao Huo, Qing Qi, Yong-Chang Lu, Zhi-Qiang Cui, Yan-Bao Liu
Mei-Chen Ji, Zhi-Jia Li, Ke Li, Yun-Xiao Wang, Bo Yang, Lin-Lin Lv, Ying Su, Zhi-Wei Zhang, Zhong-Chao Huo, Qing Qi, Oncology Center, The Affiliated Hospital of Hebei University of En-gineering, Handan 056002, Hebei Province, China
Yong-Chang Lu, General Surgery Department, Handan First Hospital, Handan 056002, Hebei Province, China
Zhi-Qiang Cui, Department of Breast Surgery, The Affiliated Hospital of Hebei University of Engineering, Handan 056002, Hebei Province, China
Yan-Bao Liu, School of Clinical Medicine, Hebei University of Engineering, Handan 056002, Hebei Province, China
Co-corresponding authors: Qing Qi and Yong-Chang Lu.
Author contributions: Ji MC and Qi Q contributed to conception and design; Li ZJ, Li K and Wang YX contributed to patient follow-up; Lu YC and Bo Y completed collection and assembly of data; Ji MC, Lv LL, Su Y and Liu YB analyzed the data and interpretation; Ji MC and Zhang ZW wrote the manuscript; Ji MC, Huo ZC and Qi Q contributed to critical review of the manuscript; and all authors have read and approve the final manuscript.
Supported by Handan City Science and Technology Research and Development Program, No. 21422083353; and The Guangdong Medical Science and Technology Research Fund, No. 20221115181236662.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the Affiliated Hospital of Hebei University of Engineering (2021[K]088).
Informed consent statement: We have no signed informed consent because this is a retrospective study and we analyzed medical records of patients in our center. We obtained a consent exemption for our research. Data availability statement.
Conflict-of-interest statement: Dr. Qi reports grants from the Handan City Science and Technology Research and Development Program.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Qing Qi, MA, Doctor, Oncology Center, The Affiliated Hospital of He-bei University of Engineering, No. 81 Congtai Road, Congtai District, Handan 056002, Hebei Province, China.
qiqing365@163.com
Received: February 17, 2024
Revised: March 25, 2024
Accepted: April 22, 2024
Published online: June 16, 2024
Processing time: 108 Days and 13.3 Hours
BACKGROUND
Radiation esophagitis (RE) is one of the most common clinical symptoms of regi-onal lymph node radiotherapy for breast cancer. However, there are fewer studies focusing on RE caused by hypofractionated radiotherapy (HFRT).
AIM
To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes.
METHODS
Between January and December 2022, we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F.
RESULTS
Of the 64 patients in this study, 24 (37.5%) did not develop RE, 29 (45.3%) developed grade 1 RE (G1RE), 11 (17.2%) developed grade 2 RE (G2RE), and none developed grade 3 RE or higher. Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose, mean dose, relative volume 20-40, and absolute volume (AV) 20-40. Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE (P < 0.001). The optimal threshold for AV30 was 2.39 mL [area under the curve (AUC): 0.996; sensitivity: 90.9%; specificity: 91.1%]. The optimal threshold for AV35 was 0.71 mL (AUC: 0.932; sensitivity: 90.9%; specificity: 83.9%).
CONCLUSION
AV30 and AV35 were significantly associated with G2RE. The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL, respectively.
Core Tip: Radiation esophagitis (RE) is a common clinical symptom among patients with breast cancer receiving regional lymph node radiotherapy. RE commonly affects patients’ quality of life and can even lead to termination of treatment. Hypofractionated radiation therapy (HFRT) is becoming a common treatment for patients with breast cancer. However, there are few studies on the occurrence of RE in patients with breast cancer undergoing HFRT. This study aimed to provide clinical guidance by analyzing the clinical and dosimetric factors contributing to the development of RE in patients with breast cancer treated with HFRT to the regional lymph nodes.
