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Abstract
BACKGROUND AND PURPOSE:
In locally advanced esophageal cancer, the optimal dose constraints for neoadjuvant chemoradiotherapy (NACRT) have yet to be established. This study is carried out to identify the most reliable dosimetric predictors for pulmonary complications following NACRT and surgery for esophageal cancer.

MATERIALS AND METHODS:
We retrospectively reviewed the medical records of 308 patients with esophageal cancer who received surgery following NACRT for locally advanced esophageal cancer from January 2005 to June 2017. Dose-volume histograms (DVH) of both lungs were computed for each patient along with total lung volume, mean lung dose (MLD), V5, V10, V20, and V30. The effect of each parameter on postoperative pulmonary complications was estimated in univariate and multivariate logistic regression analysis.

RESULTS:
Postoperative pulmonary complications occurred in 22.1% of all patients. Univariate analysis for pulmonary complications showed that location of tumor (P = 0.017), pre-RT FEV1 (P = 0.003), MLD (P = 0.002), V5 (P < 0.001), V10 (P < 0.001), and V20 (P = 0.007) were all significant risk factors. Significant factors for postoperative pulmonary complications in multivariate analysis were MLD (odds ratio (OR) 1.118, 95% confidence interval (CI) 1.025-1.219, P = 0.012) and pre-RT FEV1 (OR 0.483, 95% CI 0.294-0.795, P = 0.004).

CONCLUSIONS:
In patients who received NACRT and surgery for esophageal cancer, MLD was the parameter most related to postoperative pulmonary complications. Further studies are needed to establish the optimal DVH constraints for NACRT in order to minimize the risk of postoperative pulmonary complications in esophageal cancer patients.

Highlights: Mean lung dose having 20% risk of pulmonary complications was 9.4 Gy and 7 Gy for those with FEV1 ≥ 2L and FEV1 < 2L, respectively.

Author information

Cho WK1, Oh D2, Kim HK3, Ahn YC1, Noh JM1, Shim YM4, Zo JI4, Choi YS4, Sun JM5, Lee SH5, Ahn MJ5, Park K5, Nam H6.
1
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: dongryul.oh@samsung.com.
3
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hkts.kim@samsung.com.
4
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5
Department of Medicine (Division of Hematology-Oncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6
Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.