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Esophageal Circumferential Dose-Length Histogram Parameters to Predict Dysphagia in Patients Receiving Thoracic Radiation Therapy: A Single-Institution Experience

Year: 2025

Type: article

Abstract: Purpose Chemoradiation for locally advanced non-small cell lung cancer (NSCLC) can cause severe esophagitis. Techniques to spare the contralateral esophagus may mitigate toxicity, but traditional dose-volume histograms (DVH) do not capture the degree of circumferential irradiation. We evaluated dose-length histogram (DLH) parameters as predictors of dysphagia compared to DVH metrics. Methods We retrospectively reviewed patients treated with definitive thoracic radiotherapy from 2019 to 2023. Descriptive statistics described the cohort. Clinician-reported (CTCAE v.4) and patient-reported (PRO-CTCAE v.1) dysphagia within 120 days of treatment start were collected prospectively. McNemar's test compared dichotomized scores. The length of esophageal full-circumferential (L Fdose ) and partial-circumferential irradiation (L Pdose ) were defined as the length of esophagus with ≥90% and ≥50% circumference exposure to threshold radiation doses, respectively. Spearman correlation examined relationships between L Fdose, L Pdose, and volumetric (V dose ) parameters. Associations between L Fdose, L Pdose, and V dose , and grade ≥2 dysphagia were evaluated using univariate logistic regression. Likelihood ratio tests assessed model fit. Results Of 107 patients, 86.9% (93) had NSCLC, all received ≥60 Gy (median 63 Gy, range 60-70 Gy). and 94.4% (101) received concurrent chemotherapy. Patients and physicians reported rates of grade ≥2 dysphagia differently: 17 (15.9%) and 6 (5.6%), respectively (p=0.0015). Each 0.5 cm increase in the length of partial-circumference esophagus receiving ≥55 Gy (L P55 ) and 60 Gy (L P60 ) increased odds of PRO-CTCAE dysphagia by 8% and 9%, respectively. Each 0.5 cm increase in full-circumference esophagus receiving ≥60 Gy (L F60 ) resulted in 11% increased odds of PRO-CTCAE dysphagia. Esophageal DLH parameters, L P55 and L P60 , correlated with the esophageal V 60 volumetric parameter strongly (ρ=0.751 and 0.729, respectively). No DVH or DLH parameter predicted grade ≥2 CTCAE dysphagia. Conclusion Esophageal DLH metrics assessing partial- or full-circumferential esophageal irradiation, specifically L P55 , L P60 , and L F60 , are associated with patient-reported dysphagia and complement traditional DVH parameters.

Source: Advances in Radiation Oncology

DOI: 10.1016/j.adro.2025.101807