Current therapeutic approaches for lung cancer favor treatment intensification, with the presumption that dose-intense chemotherapy regimens and/or higher radiation therapy (RT) doses or novel fractionation schemes will result in increased patient survival. Also, the trend for non-operative therapy has favored concurrent over sequential regimens. The incidence of severe acute esophagitis in patients treated for lung cancer with standard (once daily) RT alone is 1.3%, and induction chemotherapy increases the risk of severe acute esophagitis slightly over that of standard RT alone. In contrast, a strong radiosensitizing effect of chemotherapy given concurrently with standard thoracic RT (chemoRT) is associated with an incidence of severe esophagitis of 14% to 49%. Acute esophagitis may be severe and disabling, and result in hospitalization, placement of a feeding tube in the stomach or intravenous feedings, and steady supportive care. Also, RT may need to be halted temporarily to allow for healing of the esophageal lining; treatment breaks in turn decrease survival of patients with unresectable lung cancer. Therefore, esophagitis as a dose-limiting toxicity of chemoRT may have a direct impact on tumor control and survival. Aggressive types of RT fractionation have also been associated with worsening esophagitis grades and duration. Moreover, it is commonly assumed in the radiation oncology clinic that the longer the length of the esophagus segment included in the RT field the higher the probability of esophageal toxicity, although differing opinions are commonly expressed. Recent advances in 3-dimensional conformal RT allow a unique chance to gain volumetric data pertaining to organ damage rather than rely on older estimates based on organ length (eg, esophagus) or portion (ie, lung, spinal cord). The Radiation Therapy Oncology Group (RTOG) conducted a large phase III, randomized study RTOG 98-01 examining chemoRT with or without the amifostine (Ethyol; MedImmune, Inc, Gaithersburg, MD), a cyto- and radioprotectant in locally advanced non-small cell lung cancer (n = 243). While amifostine did not significantly reduce severe esophagitis based on National Cancer Institute Common Toxicity Criteria and weekly physician dysphagia logs, swallowing dysfunction over time (based on patient diaries, the equivalent of Esophagitis Index) was significantly lower in the amifostine arm ( P = .03). Therefore, significant progress has been accomplished in our understanding of the basis of esophageal injury resulting from thoracic RT, and future effort may find other effective strategies to either minimize or eliminate esophagitis.

中文翻译：

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与治疗有关的食管炎。

当前的肺癌治疗方法倾向于强化治疗，并认为剂量密集的化疗方案和/或更高的放射治疗（RT）剂量或新颖的分级方案将导致患者生存期的延长。同样，非手术治疗的趋势也倾向于并发优于顺序治疗。单独使用标准（每日一次）RT治疗的肺癌患者中严重急性食管炎的发生率为1.3％，诱导化疗增加的严重急性食管炎的风险略高于仅使用标准RT的风险。相反，与标准胸腔放疗（chemoRT）同时给予的强烈的化学放射增敏作用与重度食管炎的发生率为14％至49％有关。急性食管炎可能很严重且致残，导致住院，在胃中放置喂食管或静脉内喂食，并持续进行支持治疗。另外，可能需要暂时停止放疗以使食管内膜愈合。中断治疗会降低无法切除的肺癌患者的生存率。因此，食管炎作为chemoRT的剂量限制性毒性可能直接影响肿瘤的控制和生存。RT分馏的激进类型也与食管炎等级和持续时间的恶化有关。此外，尽管通常表达不同意见，但放射肿瘤学诊所通常认为，RT领域中包括的食道段长度越长，食道毒性的可能性就越高。3维保形RT的最新进展为获得有关器官损伤的体积数据提供了独特的机会，而不是依赖基于器官长度（例如食道）或部位（即肺，脊髓）的较早的估计。放射治疗肿瘤学小组（RTOG）进行了一项大型的III期随机研究RTOG 98-01，研究有无氨磷汀（Ethyol; MedImmune，Inc，Gaithersburg，MD）的chemoRT，这是局部晚期非小细胞的细胞和放射防护细胞肺癌（n = 243）。尽管根据美国国家癌症研究所共同毒性标准和每周的医生吞咽困难记录，氨磷汀并没有显着减轻严重的食管炎，但氨磷汀组的吞咽功能随着时间的流逝（根据患者的日记，相当于食管炎指数）显着降低（P = .03 ）。因此，