Department of Gastrointestinal Surgery, University Hospital, Ghent, Belgium.
Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):e513-9. doi: 10.1016/j.ijrobp.2011.05.071. Epub 2011 Oct 17.
Neoadjuvant chemoradiation (CRT) is increasingly used in locally advanced esophageal cancer. Some studies have suggested that CRT results in increased surgical morbidity. We assessed the influence of CRT on anastomotic complications in a cohort of patients who underwent CRT followed by Ivor Lewis esophagectomy.
Clinical and pathologic data were collected from all patients treated with neoadjuvant CRT (36 Gy combined with 5-fluorouracil and cisplatin) followed by Ivor Lewis esophagectomy. On the radiotherapy (RT) planning computed tomography scans, normal tissue volumes were drawn encompassing the proximal esophageal region and the gastric fundus. Within these volumes, dose-volume histograms were analyzed to generate the total dose to 50% of the volume (D(50)). We studied the ability of the D(50) to predict anastomotic complications (leakage, ischemia, or stenosis). Dose limits were derived using receiver operating characteristics analysis.
Fifty-four patients were available for analysis. RT resulted in either T or N downstaging in 51% of patients; complete pathologic response was achieved in 11%. In-hospital mortality was 5.4%, and major morbidity occurred in 36% of patients. Anastomotic complications (AC) developed in 7 patients (13%). No significant influence of the D(50) on the proximal esophagus was noted on the anastomotic complication rate. The median D(50) on the gastric fundus, however, was 33 Gy in patients with AC and 18 Gy in patients without AC (p = 0.024). Using receiver operating characteristics analysis, the D(50) limit on the gastric fundus was defined as 29 Gy.
In patients undergoing neoadjuvant CRT followed by Ivor Lewis esophagectomy, the incidence of AC is related to the RT dose on the gastric fundus but not to the dose received by the proximal esophagus. When planning preoperative RT, efforts should be made to limit the median dose on the gastric fundus to 29 Gy with a V(30) below 40%.
新辅助放化疗（CRT）越来越多地用于局部晚期食管癌。一些研究表明 CRT 会增加手术发病率。我们评估了 CRT 对接受 CRT 后行 Ivor Lewis 食管切除术的患者吻合口并发症的影响。
收集所有接受新辅助 CRT（36 Gy 联合氟尿嘧啶和顺铂）治疗后行 Ivor Lewis 食管切除术的患者的临床和病理数据。在放射治疗（RT）计划 CT 扫描上，绘制包含近端食管区域和胃底的正常组织体积。在这些体积内，分析剂量-体积直方图以生成体积的 50%（D(50)）的总剂量。我们研究了 D(50)预测吻合口并发症（渗漏、缺血或狭窄）的能力。使用受试者工作特征分析得出剂量限制。
54 例患者可进行分析。RT 使 51%的患者肿瘤分期 T 或 N 降级，11%的患者获得完全病理缓解。院内死亡率为 5.4%，36%的患者发生主要并发症。7 例（13%）患者发生吻合口并发症（AC）。近端食管的 D(50)对吻合口并发症发生率无显著影响。然而，在发生 AC 的患者胃底的中位 D(50)为 33 Gy，在无 AC 的患者中为 18 Gy（p = 0.024）。使用受试者工作特征分析，将胃底的 D(50)限制定义为 29 Gy。
在接受新辅助 CRT 后行 Ivor Lewis 食管切除术的患者中，AC 的发生率与胃底的 RT 剂量有关，而与近端食管接受的剂量无关。在规划术前 RT 时，应努力将胃底的中位剂量限制在 29 Gy 以下，V(30)低于 40%。
