The lengths some people go to.

The esophagus often bears a large burden of toxicity from radiation for locally-advanced lung cancer. Three commonly used constraints focus on max dose, mean dose, and volume receiving near-prescription dose. But should we also think more about how dose is distributed across an axial slice—much like we do with the rectum in prostate cancer? This study looked at how that may influence weight loss during lung cancer treatment. Among over 200 patients, one quarter had weight loss of >5% at the end of treatment. The length of esophagus receiving a near-circumferential (>90% of the slice) dose between 50-60 Gy (L60) was significantly associated with weight loss on multivariable analysis. It was also a better predictor of weight loss than simply the volume receiving 60 Gy. Want to start asking for an L60 constraint? Well, in practice, it calls for a slice-by-slice qualitative look at the treatment plan. Using a non-adjacent wall concept during planning might be another way to limit the L60. TBL: The length of esophagus receiving a near-circumferential dose of 60 Gy appears to be a strong predictor of weight loss during lung cancer radiation. | Han, Pract Radiat Oncol 2020