Dosimetric predictors for postoperative pulmonary complications in esophageal cancer following neoadjuvant chemoradiotherapy and surgery

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), V ₅ , V ₁₀ , V ₂₀ , and V ₃₀ . 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), V ₅ (P < 0.001), V ₁₀ (P < 0.001), and V ₂₀ (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.