CLINICAL INVESTIGATION Esophagus
INDUCTION AND CONCURRENT TAXANES ENHANCE BOTH THE PULMONARY
METABOLIC RADIATION RESPONSE AND THE RADIATION PNEUMONITIS
RESPONSE IN PATIENTS WITH ESOPHAGUS CANCER
, M.D., P
, M.D., P
, B.S., C.M.D.,
, B.S., C.M.D.,
, M.D., P
Department of Gastrointestinal Medical Oncology, University of Texas
M. D. Anderson Cancer Center, Houston, TX; and
Medical Scientist Training Program, Baylor College of Medicine, Houston, TX
Purpose: The primary aim of this study was to assess pulmonary radiation toxicity quantitatively in patients who
received thoracic radiotherapy combined with induction and/or concurrent chemotherapy with or without taxanes
for esophageal cancer.
Methods and Materials: The study subjects were 139 patients treated at the University of Texas M.D. Anderson
Cancer Center for esophageal cancer and who had undergone [
F]-ﬂuorodeoxyglucose positron emission tomog-
raphy/computed tomography between November 1, 2003 and December 15, 2007 for disease restaging after che-
moradiotherapy. The patients were grouped into those who had not received taxanes (Group 1), those who had
received induction or concurrent taxanes (Group 2), and those who had received both induction and concurrent
taxanes (Group 3). Clinical pulmonary toxicity was scored using the National Cancer Institute Common Terminol-
ogy Criteria for Adverse Events, version 3. Linear regression was applied to the ﬂuorodeoxyglucose uptake vs.
radiation dose to determine the pulmonary metabolic radiation response (PMRR) for each case. The clinical
toxicity scores and PMRR among the groups were evaluated for signiﬁcance differences.
Results: The crude rate of pneumonitis symptoms was 46%, 62%, and 74% for Group 1, 2, and 3, respectively. The
analysis of variance test of log(PMRR) by treatment was signiﬁcant (p = .0046). Group 3 had a 61% greater PMRR
compared with Group 1 (p = .002). Group 2 had a 38% greater PMRR compared with Group 1 (p = .015). Finally,
Group 3 had a 17% greater PMRR compared with Group 2 (p = .31). A PMRR enhancement ratio of 1.60 (95%
conﬁdence interval, 1.19–2.14) was observed for Group 3 vs. Group 1.
Conclusion: Patients given induction and concurrent taxane chemotherapy had a signiﬁcantly greater PMRR and
clinical pneumonitis symptoms compared with the patients whose chemotherapy regimen did not include
taxanes. Ó 2010 Elsevier Inc.
Radiation pneumonitis, taxanes, positron emission tomography.
Taxanes are plant-derived chemotherapy agents considered
to be among the most effective anticancer drugs (1). Taxanes
target tumors by both promoting microtubule assembly and
inhibiting microtubule disassembly (2). Combination therapy
with taxanes and radiotherapy has been reported to be safe
and effective for patients treated for various epithelial cell
cancers, including head-and-neck (1), esophageal (3), lung
(1), and breast (4) cancer. However, therapy with paclitaxel
has been reported to cause hypersensitivity reactions (5). Re-
spiratory symptoms can develop hours to weeks after pacli-
taxel administration. Symptom severity has ranged from
Reprint requests to: Thomas Guerrero, M.D., Ph.D., Department
of Radiation Oncology, Unit 97, University of Texas M. D. Ander-
son Cancer Center, 1515 Holcombe Blvd., Houston TX 77030. Tel:
(713) 563-2300; Fax: (713) 563-2366; E-mail: tguerrero@
Supported, in part, by the University of Texas M. D. Anderson
Cancer Center’s Physician Scientist Program (T. Guerrero), with
additional funding provided by a pilot grant from the Radiation
Countermeasures Center of Research Excellence (National
Institutes of Health Grant 1U19AI067798) at Duke University
(T Guerrero); stipend support provided by a Medical Student
Research Grant from the Radiological Society of North America
and the Medical Scientist Training Program at Baylor College of
Medicine (M. McCurdy).
Presented at the American Radium Society 90th Annual Meeting,
Laguna Niguel, California, May 3–7, 2008.
Conﬂict of interest: none.
Acknowledgments—We extend our gratitude to the University of
Texas M. D. Anderson Cancer Center’s thoracic radiation oncology
faculty, thoracic surgeons, and gastrointestinal medical oncologists
whose patients were the focus of this study.
Received Oct 8, 2008, and in revised form Feb 25, 2009.
Accepted for publication Feb 27, 2009.
Int. J. Radiation Oncology Biol. Phys., Vol. 76, No. 3, pp. 816–823, 2010
Copyright Ó 2010 Elsevier Inc.
Printed in the USA. All rights reserved
0360-3016/10/$–see front matter