Chou Shang-Yu, Lu Hung-I, Chen Yen-Hao, Lo Chien-Ming, Lin Yun-Hsuan, Huang Tzu-Ting, Fang Fu-Min, Chen Li-Chun, Chen Yu, Chiu Yi-Chun, Chou Yeh-Pin, Li Shau-Hsuan, Wang Yu-Ming
Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Cancer Manag Res. 2022 May 2;14:1603-1613. doi: 10.2147/CMAR.S354667. eCollection 2022.
For locally advanced esophageal cancer, definitive concurrent chemoradiotherapy (CCRT) with a radiation dose of 50-50.4 Gy/25-28 Fx is prescribed, followed by adjuvant esophagectomy for better local control or salvage treatment if locoregional recurrence occurs. However, radiation injury before surgery may delay wound healing. We performed cervical anastomosis directly inside the left supraclavicular fossa (SCF), the irradiation target for esophageal cancer. The significance of radiation injury in patients with cervical anastomotic leak (AL) remains unclear. Thus, we assessed the influence of radiation on cervical AL in patients undergoing preoperative CCRT followed by esophagectomy.
We defined the SYC zone, a portion of the region overlapping the left SCF. The radiation dose to the SYC zone was analyzed and correlated with AL in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who were administered preoperative CCRT (radiation dose with 50-50.4 Gy/25-28 Fx to the primary esophageal tumor) followed by esophagectomy between October 2009 and January 2018. Receiver operating characteristic curve analysis and logistic regression were used to identify the optimal radiation factor to predict AL and the cutoff value.
The optimal radiation factor to predict AL was the mean dose to the SYC zone (area under the curve (AUC)=0.642), and the cutoff point of the mean dose was 48.55 Gray (Gy). For a mean SYC zone dose ≥48.55 Gy, the AL risk was sevenfold greater than that for <48.55 Gy (OR = 7.805; 95% CI: 1.184 to 51.446; P value = 0.033).
Recognizing the SYC zone as an organ at risk and performing radiation evaluation are meaningful. A reduced mean dose of the SYC zone below 48.55 Gy results in a lower cervical AL rate following esophagectomy.
对于局部晚期食管癌，规定采用50 - 50.4 Gy/25 - 28次分割的确定性同步放化疗（CCRT），随后进行辅助性食管切除术以实现更好的局部控制，或在发生局部区域复发时进行挽救性治疗。然而，手术前的放射性损伤可能会延迟伤口愈合。我们在左侧锁骨上窝（SCF）内直接进行颈部吻合术，此处是食管癌的照射靶区。放射性损伤对颈部吻合口漏（AL）患者的影响尚不清楚。因此，我们评估了术前CCRT后行食管切除术患者中放疗对颈部AL的影响。
我们定义了SYC区，即与左侧SCF重叠的部分区域。分析了2009年10月至2018年1月期间接受术前CCRT（对原发性食管肿瘤的放射剂量为50 - 50.4 Gy/25 - 28次分割）后行食管切除术的局部晚期食管鳞状细胞癌（ESCC）患者SYC区的放射剂量，并将其与AL进行相关性分析。采用受试者工作特征曲线分析和逻辑回归来确定预测AL的最佳放射因素及临界值。
预测AL的最佳放射因素是SYC区的平均剂量（曲线下面积（AUC）=0.642），平均剂量的临界值为48.55格雷（Gy）。对于SYC区平均剂量≥48.55 Gy的患者，AL风险比<48.55 Gy的患者高7倍（OR = 7.805；95%置信区间：1.184至51.446；P值 = 0.033）。
将SYC区视为危险器官并进行放射评估是有意义的。将SYC区的平均剂量降低至48.55 Gy以下可降低食管切除术后颈部AL的发生率。
