DOI: 10.4103/jcrt.jcrt_2158_25 ISSN: 1998-4138

Symptomatic esophagitis in breast cancer regional nodal irradiation: Dose–volume predictors

Osman Burak Can, Burcu Durmak İşman, Mehmet Emin Arayıcı, Özge Duran Can
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ABSTRACT

Purpose:

This study aimed to determine esophageal dose–volume parameters predictive of radiation-induced symptomatic esophagitis (RISE) in patients with breast cancer undergoing regional nodal irradiation (RNI).

Materials and Methods:

We retrospectively analyzed 246 patients (median age, 51 years; range, 25–84), all of whom received adjuvant RNI. Radiotherapy was delivered to the regional nodes with a median dose of 50 Gy (range, 45 Gy–50 Gy) in 25 fractions. Esophageal dose–volume parameters, including V5–V45Gy (absolute volume in cc), Dmax, and the mean dose of the esophagus along the supraclavicular planning target volume (Dmean), were derived from dose–volume histograms. RISE was assessed in accordance with CTCAE v5.0. ROC curve analysis was performed to evaluate the predictive power of each parameter and define optimal cut-off values.

Results:

RISE was observed in 40 of 246 patients (16.3%). All esophageal dose–volume parameters (V5-V45Gy, Dmax, and Dmean) were significantly higher in the RISE group ( P < 0.001). V25Gy and V35Gy were the most predictive parameters for RISE, with AUC values of 0.790 and 0.788, respectively. The risk of RISE was 2.4% vs. 30.1% for V25Gy < 0.75 cc vs. ≥ 0.75 cc ( P < 0.001), and 4.2% vs. 32.7% for V35Gy < 0.38 cc vs. ≥ 0.38 cc ( P < 0.001).

Conclusion:

Maintaining esophageal dose–volume parameters below the identified thresholds (V25Gy < 0.75 cc and V35Gy < 0.38 cc) may substantially reduce the risk of RISE in patients with breast cancer undergoing RNI with a 25-fraction schedule.

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