Liu Qi, Cai Xu-Wei, Fu Xiao-Long, Chen Jun-Chao, Xiang Jia-Qing
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Oncotarget. 2015 Oct 13;6(31):32220-7. doi: 10.18632/oncotarget.4730.
To identify the tolerance of radiation with a high prescribed dose and predictors for the development of intrathoracic stomach toxicity in patients with thoracic esophageal squamous cell carcinoma (SCC) after esophagectomy followed by gastric conduit reconstruction.
From 2011 to 2013, 105 patients after esophagectomy were treated with postoperative radiotherapy. The intrathoracic stomach was outlined with the calculation of a dose-volume histogram (DVH) for the initial intended treatment of 6020 cGy or 6300 cGy. The volume of the intrathoracic stomach receiving each dose was recorded at 10-Gy intervals between 10 and 40 Gy and at 5-Gy intervals between 40 and 60 Gy. The grade of toxicities was defined by the National Cancer Institute Common Toxicity Criteria version 4.0.
The mean and maximum doses of the intrathoracic stomach were 2449 ± 986 cGy and 6519 ± 406 cGy, respectively. Sixteen (15.2%) and three (2.9%) experienced Common Toxicity Criteria Grade 2 and Grade 3 acute gastric toxicity. There were no Grade 4 toxicities. Fourteen patients (13.3%) exhibited late gastric complications possibly related to radiation. The volume percent of the intrathoracic stomach receiving at least 50 Gy (V50) was strongly associated with the degree of toxicity (p = 0.024, respectively). Multivariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicities.
The intrathoracic stomach is well tolerated with a high-dose irradiation for patients with esophageal SCC receiving radiotherapy after esophagectomy. A strong dose-volume relationship exists for the development of Grade 2 acute intrathoracic stomach toxicity in our study.
确定胸段食管鳞状细胞癌（SCC）患者行食管切除及胃代食管重建术后，高处方剂量放疗的耐受性以及胸内胃毒性发生的预测因素。
2011年至2013年，105例行食管切除术后的患者接受了术后放疗。胸内胃通过剂量体积直方图（DVH）进行勾画，初始计划治疗剂量为6020 cGy或6300 cGy。记录胸内胃在10至40 Gy之间以10 Gy间隔、40至60 Gy之间以5 Gy间隔接受各剂量的体积。毒性分级依据美国国立癌症研究所通用毒性标准第4.0版。
胸内胃的平均剂量和最大剂量分别为2449±986 cGy和6519±406 cGy。16例（15.2%）和3例（2.9%）患者出现通用毒性标准2级和3级急性胃毒性。无4级毒性反应。14例患者（13.3%）出现可能与放疗相关的晚期胃并发症。胸内胃接受至少50 Gy照射的体积百分比（V50）与毒性程度密切相关（p = 0.024）。对患者及治疗相关因素的多因素分析未发现其他严重毒性的显著预测因素。
对于食管SCC患者行食管切除术后接受放疗，胸内胃对高剂量照射耐受性良好。在本研究中，2级急性胸内胃毒性的发生存在强烈的剂量 - 体积关系。
