The Impact of Lung and Heart Radiation Dose During Preoperative Chemoradiation on Overall Survival in Esophageal Cancer-A Post Hoc Analysis of CALGB 80803 (Alliance).
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41653999.
- Also identified by DOI 10.1016/j.ijrobp.2026.01.032.
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Abstract
Although technical advances have allowed for reduced radiation doses to the lungs and heart when treating esophageal cancer, doses to these organs cannot yet be eliminated completely. We conducted a post hoc analysis of CALGB 80803 (Alliance) to evaluate whether the radiation doses delivered to the heart and lungs in a prospective study with robust quality assurance were associated with overall survival (OS), and we assessed the impact of intensity modulated radiation therapy (IMRT) on adherence with protocol-specified dose constraints. Protocol-specified dose constraints were based on standard of care guidelines: total lung V10 Gy ≤ 40%, V20 Gy ≤ 20%, V30 Gy ≤ 15%, V40 Gy ≤ 10%; heart V30 Gy ≤ 30%. Post hoc dose cutpoints were calculated that best differentiated OS. A total of 225 patients underwent induction chemotherapy, where radiation modality data were available for 209/225 (92.8%); 127/209 (60.9%) were treated with IMRT. Adherence rates were high for each of the protocol-specified dose constraints: 162/209 (77.5%), 179/209 (85.6%), 207/209 (99.0%), 208/209 (99.5%), and 158/209 (75.6%); total lung: V10 Gy, V20 Gy, V30 Gy, V40 Gy, and heart V30 Gy, respectively. The heart V30 Gy ≤ 21% (P = .016) was associated with improved OS. Among patients with heart V30 Gy ≤ 21%, 8.5% and 32.3% received 3-dimensional conformal radiation therapy (3D-CRT) and IMRT, respectively (P < .001). Mean heart V30 Gy was lower in the IMRT versus the 3D-CRT group (24.7 vs 35.6; P < .001). On multivariable analysis, lung V10 Gy > 42% (hazard ratio [HR], 1.71; P = .017) and heart V30 Gy > 21% (HR, 1.86; P = .013) were associated with worse OS. Most patients on CALGB 80803 (Alliance) were treated with IMRT plans that met protocol-specified dose constraints for total lung and heart. Minimizing low dose volume to the lungs (V10 Gy) and minimizing heart V30 Gy were associated with a significant survival benefit. Total lung V10 Gy ≤ 42% and heart V30 Gy ≤ 21%, and utilization of IMRT over 3D-CRT, should be considered when designing radiation plans for patients with esophageal cancer.