Table 3.

Incidence rates of acute esophagitis with different treatment RT techniques for non-small cell lung cancer

Treatment	Regimena	Technique/N	Acute esophagitis	Reference
Curative-intent conventional RT with concurrent cytotoxic chemotherapy	• 60 Gy or 74 Gy • Carboplatin and paclitaxel	IMRT or 3DCRT N=544	• ≥ Grade 3d: 21% vs 7% • ≥ Grade 4: 0	28
	• Median dose 65Gy • Platinum-based chemotherapy	IMRT or 3DCRT N=1,082b	• Grade 2: 32.2% • Grade 3: 17.1% • Grade 4: 0.9% • Grade 5: 0	27
	• 69.6 Gy/58 delivered as 1.2 Gy BID • Cisplatin and etoposide	2D/N=528b	• ≥ Grade 2: 75% of patients (no difference between arms) • ≥ Grade 3: 70% in hyperfractionated arm vs 22% in standard RT arms (P<0.0001) • ≥ Grade 4: 2%	10
	• 63 Gy • Cisplatin and vinblastine
	• 69.6 Gy • Cisplatin and vinblastine
	• 60 Gy • Sequential cisplatin and vinblastine or etoposide	2D/N=461b	• Grade ≥3: 1.3%	24
	• 6 0 Gy • Sequential and concurrent cisplatin and vinblastine or etoposide		• Grade ≥3: 6%
	• 69.6 Gy/58 delivered as 1.2 Gy BID • Concurrent cisplatin and vinblastine or etoposide		• Grade ≥3d: 34%
	• Concurrent CRT • Sequential CRT	2D in five trials 3DCRT in one trial N=1,205b	• Grades 3–4: 4% with sequential and 18% with concurrent CRT (RR 4.9; 95% CI 3.1–7.8, P<0.01)	63
CHART versus curative-intent conventional RT	• 54 Gy/36 delivered as 1.5 Gy TID over 12 consecutive days (CHART) • 60 Gy (conventional)	2D/N=563	• Acute severe dysphagia: 19% (CHART) vs 3% (no P-value)	26
SBRT	• 45 Gy/5	SBRT/N=108	• When median esophageal maximum dose >30 Gy, grade >2 esophagitis seen in 50% when target volume overlapped the esophagus	64
	• 54 Gy/3c	SBRT/N=44	GI adverse events: • Grade 1: 7.3% • Grade 2: 1.8% • Grade 3: 1.8% • Grade 4–5: 0%	65
Palliative-intent conventional RT	• 25 Gy/10 followed by 2 week break, followed by 25–32.5Gy/10–13 (split course)	2D or 3DCRT N=140	Acute esophagitis: • Mild 34% • Moderate to severe 10%	30
	• Various regimense	2D or 3DCRT N=3473b	Physician-assessed dysphagia: • Low-dose regimens: 15% • High-dose regimens: 21%	3

Notes:

^aStandard fractionation of 1.8–2 Gy per day unless otherwise specified.

^bMeta-analysis.

^cT1 or T2 tumors >2 cm from proximal bronchial tree.

^dSignificantly higher in higher RT dose arm.

^eLow-dose regimens delivered <35 Gy/10 and high-dose regimens delivered >35 Gy/10.

Abbreviations: 2D, two dimensional; 3DCRT, three-dimensional conformal radiation therapy; BID, twice per day; CHART, continuous hyperfractionated accelerated radiation therapy; IMRT, intensity-modulated radiation therapy; RT, radiotherapy; SBRT, stereotactic body radiotherapy; TID, three times per day.