Development, external validation and clinical usefulness of a practical prediction model for radiation-induced dysphagia in lung cancer patients

Cary Dehing-Oberije*, Dirk De Ruysscher, Steven Petit, Jan Van Meerbeeck, Katrien Vandecasteele, Wilfried De Neve, Anne Marie C. Dingemans, Issam El Naqa, Joseph O. Deasy, Jeff Bradley, Ellen Huang, Philippe Lambin

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

86 Downloads (Pure)


Introduction: Acute dysphagia is a distressing dose-limiting toxicity occurring frequently during concurrent chemo-radiation or high-dose radiotherapy for lung cancer. It can lead to treatment interruptions and thus jeopardize survival. Although a number of predictive factors have been identified, it is still not clear how these could offer assistance for treatment decision making in daily clinical practice. Therefore, we have developed and validated a nomogram to predict this side-effect. In addition, clinical usefulness was assessed by comparing model predictions to physicians' predictions. Materials and methods: Clinical data from 469 inoperable lung cancer patients, treated with curative intent, were collected prospectively. A prediction model for acute radiation-induced dysphagia was developed. Model performance was evaluated by the c-statistic and assessed using bootstrapping as well as two external datasets. In addition, a prospective study was conducted comparing model to physicians' predictions in 138 patients. Results: The final multivariate model consisted of age, gender, WHO performance status, mean esophageal dose (MED), maximum esophageal dose (MAXED) and overall treatment time (OTT). The c-statistic, assessed by bootstrapping, was 0.77. External validation yielded an AUC of 0.94 on the Ghent data and 0.77 on the Washington University St. Louis data for dysphagia >= grade 3. Comparing model predictions to the physicians' predictions resulted in an AUC of 0.75 versus 0.53, respectively. Conclusions: The proposed model performed well was successfully validated and demonstrated the ability to predict acute severe dysphagia remarkably better than the physicians. Therefore, this model could be used in clinical practice to identify patients at high or low risk.
Original languageEnglish
Pages (from-to)455-461
JournalRadiotherapy and Oncology
Issue number3
Publication statusPublished - Dec 2010


  • Dysphagia
  • Nomogram
  • Prediction model
  • Lung cancer


Dive into the research topics of 'Development, external validation and clinical usefulness of a practical prediction model for radiation-induced dysphagia in lung cancer patients'. Together they form a unique fingerprint.

Cite this