Contralateral esophagus–sparing technique in locally advanced lung cancer treated with chemoradiation
JAMA — Kamran SC, Yeap BY, Ulysse CA, et al. | June 18, 2021
In this study of patients with locally advanced non–small cell lung carcinoma (with or without solitary brain metastasis) or limited-stage small cell lung carcinoma with gross tumor within 1 cm of the esophagus, researchers investigated if formalized sparing of the contralateral esophagus (CE) was related to a decreased risk of severe acute esophagitis, given severe acute esophagitis is encountered in up to 20% of cases with locally advanced lung cancer managed with chemoradiation therapy to at least 60 Gy once daily. Interventions included intensity-modulated radiation therapy to 70 Gy at 2 Gy/fraction concurrent with standard chemotherapy with or without adjuvant durvalumab. To guide a steep dose falloff gradient, esophageal wall contralateral to gross tumor was contoured as an avoidance structure. Experts prioritized target coverage over CE sparing, and 70 Gy and at least 63 Gy had to cover 99% of internal and planning target volumes, respectively. Findings of this phase 1 nonrandomized clinical trial revealed decreased risk of esophagitis in relation to the CE-sparing technique use in patients managed uniformly with chemoradiation therapy (to 70 Gy), with no grade 3 or higher esophagitis despite tumor within 1 cm of the esophagus. This technique may be translated into clinical practice.
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