Kundel Yulia, Kurman Noga, Sulimani Omri, Gavrielli Shlomo, Nachalon Yuval, Moore Assaf, Kashtan Hanoch, Fenig Eyal, Brenner Baruch, Popovtzer Aron, Fredman Elisha
Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.
Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Oncol. 2023 Feb 28;13:1080089. doi: 10.3389/fonc.2023.1080089. eCollection 2023.
Standard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation dose exposure had been inconclusive. We examined the correlation between radiation exposure to the gastric fundus and risk of postoperative leakage using contemporary radiation doses and fractionation.
A total of 69 consecutive patients with LAEC who underwent neoadjuvant chemoradiotherapy followed by esophagectomy in our tertiary center were prospectively followed (median, 27 months). Neoadjuvant regimen included 50.4 Gy in 28 fractions with 5-fluorouracil and cisplatin and 41.4 Gy in 23 fractions with carboplatin and paclitaxel. The gastric fundus was contoured and dosimetric and radiation technique parameters were retrospectively evaluated.
Of the total number of patients, 71% and 29% had esophageal and gastroesophageal junction (GEJ) tumors, respectively. Fourteen patients (20.3%) experienced anastomotic leaks within a median of 2 days postoperatively, 78.6% of whom had lower third esophagus or GEJ primaries. Mean and minimum fundus dose did not significantly differ between those with and those without leakage ( = 0.42, = 0.51). Mean fundus V25, V30, and V35 doses were numerically but not statistically higher in those with anastomotic leak ( = 0.58, = 0.39, and = 0.30, respectively). No correlation with incidence of leakage was seen between 3D and IMRT treatment modalities.
In our comparatively large prospectively collected series of patients treated for LAEC, radiation dose to the gastric fundus during neoadjuvant combination therapy prior to surgery did not correlate with the risk of postoperative anastomotic leak.
局部晚期食管癌（LAEC）的标准治疗方案包括新辅助放化疗，然后进行食管切除术。一种潜在的灾难性手术并发症是术后吻合口漏的发生。迄今为止，与辐射剂量暴露之间的关联尚无定论。我们使用当代的辐射剂量和分割方式，研究了胃底辐射暴露与术后漏的风险之间的相关性。
我们前瞻性地随访了在我们三级中心接受新辅助放化疗后行食管切除术的69例连续LAEC患者（中位随访时间为27个月）。新辅助治疗方案包括：28次分割给予50.4 Gy，联合5-氟尿嘧啶和顺铂；23次分割给予41.4 Gy，联合卡铂和紫杉醇。对胃底进行轮廓勾画，并回顾性评估剂量测定和放射技术参数。
在所有患者中，分别有71%和29%患有食管肿瘤和食管胃交界（GEJ）肿瘤。14例患者（20.3%）在术后中位2天内发生吻合口漏，其中78.6%的患者原发肿瘤位于食管下三分之一或GEJ。发生漏与未发生漏的患者之间，胃底的平均剂量和最小剂量无显著差异（P = 0.42，P = 0.51）。发生吻合口漏的患者，胃底V25、V30和V35的平均剂量在数值上较高，但无统计学意义（分别为P = 0.58，P = 0.39，P = 0.30）。三维适形放疗（3D）和调强放疗（IMRT）治疗方式与漏的发生率均无相关性。
在我们前瞻性收集的相对较大的LAEC治疗患者系列中，术前新辅助联合治疗期间胃底的辐射剂量与术后吻合口漏的风险无关。
