Abstract
To identify the tolerance of radiation with a high prescribed dose and predictors for the development of intrathoracic stomach toxicity in patients with thoracic esophageal squamous cell carcinoma (SCC) after esophagectomy followed by gastric conduit reconstruction. From 2011 to 2013, 105 patients after esophagectomy were treated with postoperative radiotherapy. The intrathoracic stomach was outlined with the calculation of a dose-volume histogram (DVH) for the initial intended treatment of 6020 cGy or 6300 cGy. The volume of the intrathoracic stomach receiving each dose was recorded at 10-Gy intervals between 10 and 40 Gy and at 5-Gy intervals between 40 and 60 Gy. The grade of toxicities was defined by the National Cancer Institute Common Toxicity Criteria version 4.0. The mean and maximum doses of the intrathoracic stomach were 2449 ± 986 cGy and 6519 ± 406 cGy, respectively. Sixteen (15.2%) and three (2.9%) experienced Common Toxicity Criteria Grade 2 and Grade 3 acute gastric toxicity. There were no Grade 4 toxicities. Fourteen patients (13.3%) exhibited late gastric complications possibly related to radiation. The volume percent of the intrathoracic stomach receiving at least 50 Gy (V50) was strongly associated with the degree of toxicity (p = 0.024, respectively). Multivariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicities. The intrathoracic stomach is well tolerated with a high-dose irradiation for patients with esophageal SCC receiving radiotherapy after esophagectomy. A strong dose-volume relationship exists for the development of Grade 2 acute intrathoracic stomach toxicity in our study.
Highlights
The intrathoracic stomach is well tolerated with a high-dose irradiation for patients with esophageal squamous cell carcinoma (SCC) receiving radiotherapy after esophagectomy
A strong dose-volume relationship exists for the development of Grade 2 acute intrathoracic stomach toxicity in our study
Existing evidences have indicated that overall survival (OS) could be improved using neoadjuvant chemoradiotherapy followed by surgery for esophageal cancer [1]
Summary
Existing evidences have indicated that overall survival (OS) could be improved using neoadjuvant chemoradiotherapy followed by surgery for esophageal cancer [1]. According to previous studies the recurrence rate of SCC is as high as 40%–50% after radical surgery, and locoregional recurrence accounts for more than half of treatment failures [3,4], even among patients with a pathologically complete response to neoadjuvant chemoradiotherapy [5]. Recurrences in www.impactjournals.com/oncotarget supraclavicular and superior mediastinal areas were the most common failures [6,7]. It further necessitates the need for adjuvant therapy to decrease the likehood of local recurrence, especially for patients with positive lymph nodes [8,9]. The radiation dose is - as high as possible for patients with limited lesions
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