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David S. Ettinger, MD, FACP, FCCP


Does Esophageal-Sparing Radiotherapy Reduce the Risk of Esophagitis in Advanced NSCLC?

By: Julia Fiederlein
Posted: Monday, July 25, 2022

In the multicenter, phase III PROACTIVE trial, esophageal-sparing intensity-modulated radiotherapy did not seem to significantly improve esophageal quality of life for patients with advanced non–small cell lung cancer (NSCLC). However, according to David A. Palma, MD, PhD, of the London Health Sciences Centre, Ontario, and colleagues, this type of radiotherapy that spared the esophagus was found to significantly reduce the incidence of symptomatic radiotherapy-related esophagitis. The results, which were published in JAMA Oncology, support the implementation of this modern technique into clinical practice.

“[The] post hoc analysis found that reduced esophagitis was most evident in patients receiving 30 Gy of radiotherapy,” the investigators commented. “These findings suggest that esophageal-sparing intensity-modulated radiotherapy may be most beneficial when the prescription dose is higher.”

Between June 2016 and March 2019, a total of 90 patients with stage III or IV incurable disease were randomly assigned in a 1:1 ratio to undergo standard palliative radiotherapy or esophageal-sparing intensity-modulated radiotherapy. Of this population, 40% received 20 Gy in 5 fractions, and 60% received 30 Gy in 10 fractions.

The mean 2-week esophageal cancer subscale scores were 54.3 and 50.5 with esophageal-sparing intensity-modulated radiotherapy and standard radiotherapy, respectively (P = .06). The incidence rate of symptomatic radiotherapy-associated esophagitis seemed to be significantly lower with esophageal-sparing intensity-modulated radiotherapy than with standard radiotherapy (2% vs. 24%; P = .002); in a post hoc subgroup analysis, this benefit was most evident in patients who received a dose of 30 Gy of radiotherapy (30% vs. 0%; P = .004). The median duration of overall survival did not seem to significantly differ between the treatment arms (esophageal-sparing intensity-modulated radiotherapy: 8.7 months; standard radiotherapy: 8.6 months; P = .62).

Disclosure: For full disclosures of the study authors, visit

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