Ólafsdóttir Halla Sif, Dalqvist Emmy, Onjukka Eva, Klevebro Fredrik, Nilsson Magnus, Gagliardi Giovanna, Alexandersson von Döbeln Gabriella
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 52 Huddinge, Sweden.
Department of Radiotherapy, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-171 64 Solna, Sweden.
Clin Transl Radiat Oncol. 2023 Mar 4;40:100610. doi: 10.1016/j.ctro.2023.100610. eCollection 2023 May.
Complications after esophagectomy are common and the possible increase in postoperative complications associated with neoadjuvant chemoradiotherapy is of concern. The aim of our study was to analyze if the addition of radiotherapy to neoadjuvant chemotherapy increases the incidence and severity of postoperative complications, including evaluation of the relation between radiation doses to the heart and lungs and postoperative complications.
The study was based on an institutional surgical database for esophageal cancer. The study period was October 2008 to March 2020. Patients treated with neoadjuvant chemoradiotherapy were compared to patients treated with neoadjuvant chemotherapy and dose/volume parameters for the lungs and heart considered. The primary outcome was 30-day postoperative complications.
During the study period, 274 patients underwent surgery for esophageal cancer, 93 patients after neoadjuvant chemotherapy and 181 patients after neoadjuvant chemoradiotherapy. The median prescribed radiation dose to the planning target volume was 41.4 Gy, the median of the mean lung dose was 6.2 Gy, and the median of the mean heart dose was 20.3 Gy. The addition of radiotherapy to neoadjuvant chemotherapy did not increase the incidence of postoperative complications. Neither were radiation doses to the lungs and heart associated with postoperative complications. Taxane-based chemotherapy regimens were however associated with an increased incidence of postoperative complications.
In our cohort, the addition of neoadjuvant radiotherapy to chemotherapy was not associated with postoperative complications. However, taxane-based chemotherapy regimens, with or without concomitant radiotherapy, were associated with postoperative complications.
食管癌切除术后并发症很常见，新辅助放化疗相关的术后并发症可能增加令人担忧。我们研究的目的是分析在新辅助化疗中加入放疗是否会增加术后并发症的发生率和严重程度，包括评估心脏和肺部的辐射剂量与术后并发症之间的关系。
该研究基于一个机构的食管癌手术数据库。研究时间段为2008年10月至2020年3月。将接受新辅助放化疗的患者与接受新辅助化疗的患者进行比较，并考虑肺部和心脏的剂量/体积参数。主要结局是术后30天并发症。
在研究期间，274例患者接受了食管癌手术，93例接受新辅助化疗，181例接受新辅助放化疗。计划靶体积的中位处方辐射剂量为41.4 Gy，平均肺剂量的中位数为6.2 Gy，平均心脏剂量的中位数为20.3 Gy。在新辅助化疗中加入放疗并未增加术后并发症的发生率。肺部和心脏的辐射剂量与术后并发症也无关。然而，基于紫杉烷的化疗方案与术后并发症发生率增加有关。
在我们的队列中，新辅助放疗加化疗与术后并发症无关。然而，基于紫杉烷的化疗方案，无论是否同时进行放疗，都与术后并发症有关。
