Influence of the extent and dose of radiation on complications after neoadjuvant chemoradiation and subsequent esophagectomy with gastric tube reconstruction with a cervical anastomosis

Publication date: Available online 14 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): M. Koëter, N. Kathiravetpillai, J.A. Gooszen, M.I. van Berge Henegouwen, S.S. Gisbertz, M.J.C. van der Sangen, M.D.P. Luyer, G.A.P. Nieuwenhuijzen, M.C.C.M. Hulshof
BackgroundThe influence of the extent and dose of radiation on complications was investigated in patients with esophageal cancer treated with neoadjuvant chemoradiation and subsequent esophagectomy with gastric tube reconstruction with a cervical anastomosis.MethodsBetween 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, upper planning target volume (PTV) border in relation to mediastinal length expressed as the mediastinal ratio were calculated.ResultsAnastomotic leakage (AL) occurred in 22% and anastomotic stenosis (AS) in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of AL or AS. In 28% of the patients severe complications (Clavien-Dindo score of ≥ IIIB) occurred. The presence of multiple co-morbidities (HR 2.4 [CI 1.3-4.5], p=0.006) and a mediastinal ratio of 0.5-1.0 (HR 1.9 [CI 1.0-3.5], p=0.036) were both independent predictors of severe complications.DiscussionWith 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 PTV border.



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