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Title: Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis

Abstract

Purpose: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. Methods and Materials: Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated. Results: Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. Conclusion: With a mean radiation dose of 24.2 Gy to the futuremore » anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.« less

Authors:
;  [1]; ; ;  [2];  [3];  [1];  [1];  [4]
  1. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven (Netherlands)
  2. Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam (Netherlands)
  3. Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven (Netherlands)
  4. Department of Radiation Oncology, Academic Medical Centre Amsterdam, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
22649871
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 97; Journal Issue: 4; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; GY RANGE 10-100; LEAKS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; REGRESSION ANALYSIS

Citation Formats

Koëter, M., Kathiravetpillai, N., Gooszen, J.A., Berge Henegouwen, M.I. van, Gisbertz, S.S., Sangen, M.J.C. van der, Luyer, M.D.P., Nieuwenhuijzen, G.A.P., E-mail: grard.nieuwenhuijzen@catharinaziekenhuis.nl, and Hulshof, M.C.C.M. Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2016.11.054.
Koëter, M., Kathiravetpillai, N., Gooszen, J.A., Berge Henegouwen, M.I. van, Gisbertz, S.S., Sangen, M.J.C. van der, Luyer, M.D.P., Nieuwenhuijzen, G.A.P., E-mail: grard.nieuwenhuijzen@catharinaziekenhuis.nl, & Hulshof, M.C.C.M. Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis. United States. doi:10.1016/J.IJROBP.2016.11.054.
Koëter, M., Kathiravetpillai, N., Gooszen, J.A., Berge Henegouwen, M.I. van, Gisbertz, S.S., Sangen, M.J.C. van der, Luyer, M.D.P., Nieuwenhuijzen, G.A.P., E-mail: grard.nieuwenhuijzen@catharinaziekenhuis.nl, and Hulshof, M.C.C.M. Wed . "Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis". United States. doi:10.1016/J.IJROBP.2016.11.054.
@article{osti_22649871,
title = {Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis},
author = {Koëter, M. and Kathiravetpillai, N. and Gooszen, J.A. and Berge Henegouwen, M.I. van and Gisbertz, S.S. and Sangen, M.J.C. van der and Luyer, M.D.P. and Nieuwenhuijzen, G.A.P., E-mail: grard.nieuwenhuijzen@catharinaziekenhuis.nl and Hulshof, M.C.C.M.},
abstractNote = {Purpose: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. Methods and Materials: Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated. Results: Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. Conclusion: With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.},
doi = {10.1016/J.IJROBP.2016.11.054},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 97,
place = {United States},
year = {Wed Mar 15 00:00:00 EDT 2017},
month = {Wed Mar 15 00:00:00 EDT 2017}
}