Bang Andrew, Broomfield Joel A, Chan Jessica, Alyamani Najlaa, Crnic Agnes, Gilbert Sebastien, Pantarotto Jason R
Division of Radiation Oncology, University of Ottawa. 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario M5G 2C1, Canada.
Clin Transl Radiat Oncol. 2019 Jan 24;15:76-82. doi: 10.1016/j.ctro.2018.12.005. eCollection 2019 Feb.
There is conflicting evidence with respect to the correlation between neoadjuvant chemoradiation and anastomotic complications following trimodality therapy in patients with esophageal cancer. We aimed to analyze the relationship between their dosimetry and any resulting anastomotic complications.
The medical records of 51 consecutive patients who underwent trimodality therapy between 2007 and 2014 were retrospectively reviewed. We analyzed the differences in the mean dose received by regions of the esophagus relative to the landmark of the azygous vein and the stomach to correlate the development of an anastomotic complication using nonparametric rank-sum tests.
Anastomotic leakage and stricture rates were 12% and 22%, respectively. Patients with anastomotic complications received a statistically significant higher mean dose to the esophagus at the level of the azygous vein (0.0 cm) and lower (up to -2.7 cm) (28.4-42.2 Gy vs. 10.3-27.6 Gy, p < 0.04). There were no differences noted in mean gastric doses. Median follow up time was 30.9 months. Median overall survival and disease free survival of our patient cohort was 34.4 months and 22.5 months, respectively. The development of an anastomotic complication did not affect survival outcomes.
Patients who experienced anastomotic complication after trimodality therapy for esophageal cancer were more likely to have received a higher mean esophageal dose around the proximity of the azygous vein, where intrathoracic anastomoses most commonly occur. Communication between surgical and radiation oncologists regarding the anastomotic location may be an important consideration in planning for trimodality therapy in reducing potential anastomotic complications.
关于新辅助放化疗与食管癌患者三联疗法后吻合口并发症之间的相关性，证据存在冲突。我们旨在分析它们的剂量学与任何由此产生的吻合口并发症之间的关系。
回顾性分析了2007年至2014年间连续接受三联疗法的51例患者的病历。我们分析了食管各区域相对于奇静脉和胃的标志点所接受的平均剂量差异，以使用非参数秩和检验来关联吻合口并发症的发生情况。
吻合口漏和狭窄率分别为12%和22%。发生吻合口并发症的患者在奇静脉水平（0.0 cm）及更低水平（至 -2.7 cm）的食管接受的平均剂量在统计学上显著更高（28.4 - 42.2 Gy对10.3 - 27.6 Gy，p < 0.04）。胃的平均剂量未发现差异。中位随访时间为30.9个月。我们患者队列的中位总生存期和无病生存期分别为34.4个月和22.5个月。吻合口并发症的发生并不影响生存结果。
食管癌三联疗法后发生吻合口并发症的患者，在奇静脉附近更有可能接受了较高的食管平均剂量，而胸内吻合最常发生在此处。在规划三联疗法以减少潜在的吻合口并发症时，外科肿瘤学家和放疗肿瘤学家之间就吻合口位置进行沟通可能是一个重要的考虑因素。
