Association between Systemic Chemotherapy before Chemoradiation and Increased Risk of Treatment-Related Pneumonitis in Esophageal Cancer Patients Treated with Definitive Chemoradiotherapy

BackgroundThere is limited information on risk factors for treatment-related pneumonitis in esophageal cancer patients.Aim of the StudyTo determine factors associated with treatment-related pneumonitis in esophageal cancer patients treated with definitive chemoradiotherapy.Materials and MethodsWe retrospectively reviewed clinical data from esophageal cancer patients treated with definitive chemoradiotherapy from 2000 to 2003. Demographic, clinical, and treatment-related data were collected for all patients. The time to occurrence of grade ≥2 pneumonitis was calculated from the end of radiotherapy. Univariate analyses were performed to determine the existence of any association between patient demographic, clinical, or treatment characteristics and pneumonitis.ResultsIn total, 96 patients were included in the study with a median follow-up of 8 months (range, <1–48 months). Among them, 23 patients also received an average of two cycles of systemic chemotherapy before the initiation of concurrent chemoradiation. The incidence of grade ≥2 pneumonitis was 22% at 1 year. Systemic chemotherapy before concurrent chemoradiation was significantly associated with an increased risk of grade ≥2 pneumonitis (p = 0.003), with the 1-year incidence of grade ≥2 pneumonitis for patients with and without systemic chemotherapy being 49 and 14%, respectively. No other clinical or dosimetric factors investigated were associated with the risk of grade ≥2 pneumonitis.ConclusionsSystemic chemotherapy before concurrent chemoradiation was significantly associated with an increased risk of grade ≥2 pneumonitis, suggesting that induction chemotherapy may have sensitized the lung tissue to radiation damage in esophageal cancer patients.