Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

Payal D. Soni, Philip S. Boonstra, Matthew J. Schipper, Latifa Bazzi, Robert T. Dess, Martha M. Matuszak, Feng Ming Kong, James A. Hayman, Randall K. Ten Haken, Theodore S. Lawrence, Gregory P. Kalemkerian, Shruti Jolly

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients. Methods A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database. Results In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95% confidence intervals of 0.88–0.98 and 0.87–0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis. Conclusions There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.

Original languageEnglish (US)
Pages (from-to)539-546
Number of pages8
JournalJournal of Thoracic Oncology
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Esophagitis
Lung Neoplasms
Radiotherapy
Incidence
Lung
Radiation Oncology
Pneumonia
Thorax
Databases
Radiation
Drug Therapy
Aptitude
Area Under Curve
Registries
Randomized Controlled Trials
Logistic Models
Smoking
Confidence Intervals
Therapeutics

Keywords

  • Elderly
  • Esophagitis
  • Lung Cancer
  • Radiation
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Soni, P. D., Boonstra, P. S., Schipper, M. J., Bazzi, L., Dess, R. T., Matuszak, M. M., ... Jolly, S. (2017). Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer. Journal of Thoracic Oncology, 12(3), 539-546. https://doi.org/10.1016/j.jtho.2016.11.2227

Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer. / Soni, Payal D.; Boonstra, Philip S.; Schipper, Matthew J.; Bazzi, Latifa; Dess, Robert T.; Matuszak, Martha M.; Kong, Feng Ming; Hayman, James A.; Ten Haken, Randall K.; Lawrence, Theodore S.; Kalemkerian, Gregory P.; Jolly, Shruti.

In: Journal of Thoracic Oncology, Vol. 12, No. 3, 01.03.2017, p. 539-546.

Research output: Contribution to journalArticle

Soni, PD, Boonstra, PS, Schipper, MJ, Bazzi, L, Dess, RT, Matuszak, MM, Kong, FM, Hayman, JA, Ten Haken, RK, Lawrence, TS, Kalemkerian, GP & Jolly, S 2017, 'Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer', Journal of Thoracic Oncology, vol. 12, no. 3, pp. 539-546. https://doi.org/10.1016/j.jtho.2016.11.2227
Soni, Payal D. ; Boonstra, Philip S. ; Schipper, Matthew J. ; Bazzi, Latifa ; Dess, Robert T. ; Matuszak, Martha M. ; Kong, Feng Ming ; Hayman, James A. ; Ten Haken, Randall K. ; Lawrence, Theodore S. ; Kalemkerian, Gregory P. ; Jolly, Shruti. / Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer. In: Journal of Thoracic Oncology. 2017 ; Vol. 12, No. 3. pp. 539-546.
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abstract = "Introduction Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients. Methods A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database. Results In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95{\%} confidence intervals of 0.88–0.98 and 0.87–0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis. Conclusions There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.",
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AU - Dess, Robert T.

AU - Matuszak, Martha M.

AU - Kong, Feng Ming

AU - Hayman, James A.

AU - Ten Haken, Randall K.

AU - Lawrence, Theodore S.

AU - Kalemkerian, Gregory P.

AU - Jolly, Shruti

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N2 - Introduction Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients. Methods A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database. Results In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95% confidence intervals of 0.88–0.98 and 0.87–0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis. Conclusions There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.

AB - Introduction Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients. Methods A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database. Results In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95% confidence intervals of 0.88–0.98 and 0.87–0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis. Conclusions There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.

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