The other side

During treatment planning for locally advanced NSCLC, how much attention do you pay to the amount of prescription dose passing through the entire esophagus? That near-circumferential dose has been more strongly associated with esophageal toxicity than just the volume of esophagus receiving 60 Gy. This phase 1 study from MGH strictly controlled dose to the esophageal wall contralateral to the target volume. Using a prescription of 70 Gy in 35 fractions, the median max dose to the CE was 66 Gy, median V55 was 1.4 cc, and median V45 was 2.7 cc. None of the 25 patients experienced grade 3+ esophagitis. While covering the target is priority, purposefully sparing the contralateral esophageal wall may reduce the severity of esophageal toxicity. | Kamran, JAMA Oncol 2021