scholarly journals Does Radiation Dose to Gastric Fundus during Neoadjuvant Chemoradiotherapy for Esophageal Carcinoma Have an Impact on Postoperative Anastomotic Leak?

2021 ◽  
pp. 86-92
Author(s):  
Nikhila Radhakrishna ◽  
Shyama Prem Sudha ◽  
Raja Kalayarasan ◽  
Prasanth Penumadu
Keyword(s):  
Logistic Regression ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Anastomotic Leak ◽  
Neoadjuvant Chemoradiotherapy ◽  
Gastric Fundus ◽  
Thoracic Esophagus ◽  
Trimodality Therapy ◽  
Dose Volume ◽  
Postoperative Anastomotic Leak

Background: Radiation dose received by the gastric fundus (GF) in neoadjuvant chemoradiotherapy (NACRT) may influence the development of postoperative anastomotic leak (AL) in the management of resectable esophageal carcinoma (EC) by trimodality therapy. The present study aims to evaluate dose-volume parameters of the GF and their association with occurrence of AL in EC. Materials and Methods: A retrospective analysis was performed of 27 patients with EC who underwent NACRT followed by esophagectomy with cervical esophagogastric anastomosis between January 2015 and July 2018. The GF was retrospectively contoured; dose-volume parameters of the GF were recorded. Postoperative AL was identified from surgical records. Logistic regression analysis was used to identify risk factors associated with AL. Results: The mean age of the patients was 51 ± 10.5 years; 56% (15/27) had involvement of lower 1/3 esophagus, 10/27 (37%) midthoracic esophagus, and 2/27 (7%) upper thoracic esophagus; 40% (11/27) patients developed postoperative AL and 7/11 had distal and 4/11 had mid thoracic esophageal lesions. Four of five (80%) patients treated by 3-dimensional conformal radiotherapy versus 7/22 (32%) patients treated by volumetric modulated arc therapy developed AL (p = 0.12). Univariate logistic regression revealed no significant correlation between Dmean, Dmax, V20, V25, V30, V35, D50, and AL. 8/27 patients underwent ischemic preconditioning of gastric conduit, and 2/8 had AL; 19/27 did not undergo preconditioning, and 9/19 patients experienced AL (p = 0.4). Conclusion: There was no significant negative impact of the dose received by the GF in NACRT upon AL rates. Further studies with a larger sample size are required to clarify this issue.

Predicting acute small-bowel toxicity in patients with rectal cancer treated with neoadjuvant chemoradiation: A comparison of peritoneal space versus small-bowel loop contouring techniques.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 673-673
Author(s):  
Robyn Banerjee ◽  
Santam Chakraborty ◽  
Ian Nygren ◽  
Richie Sinha
Keyword(s):  
Rectal Cancer ◽  
Logistic Regression ◽  
Small Bowel ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Characteristic Analysis ◽  
Dose Volume ◽  
Peritoneal Space ◽  
Grade 3

673 Background: In lieu of contouring individual small bowel loops, the peritoneal space (PS) has been suggested as a possible surrogate volume for predicting small bowel toxicity. A dose-volume relationship for the PS has not been firmly established. The aim of this study was to determine whether contours of the PS better predict significant acute small bowel toxicity in neoadjuvant rectal cancer patients when compared with contours of individual small bowel loops. Methods: A standardized contouring method was developed for the PS and retrospectively applied to the radiation treatment plans of sixty-seven patients treated with neoadjuvant chemoradiotherapy for rectal cancer. All patients had locally advanced disease, no evidence of metastases, and received concurrent radiation and infusional 5-Fluorourocil chemotherapy. Dose-volume histogram (DVH) data was extracted and analyzed against patient toxicity. Receiver operating characteristic analysis and logistic regression was carried out for both contouring methods. Results: Grade ≥ 3 small bowel toxicity occurred in 16% (11/67) of patients. Volumes of the contoured small bowel loops correlated with grade ≥ 3 toxicity at each 5 Gray (Gy) dose level from 5 to 45 Gy, with the greatest area under the curve (AUC) measuring .964 (p=.000) associated with the volume receiving at least 25 Gy (V25). Volumes of the contoured PS predicted toxicity from 5 to 40 Gy, with the greatest AUC also at the V25 and measuring .896 (p=.000). Logistic regression analysis demonstrated a less than 15% risk of acute grade ≥ 3 toxicity was associated with a V25 of 215 cc for the small bowel and 710 cc for the PS. Conclusions: DVH analysis of peritoneal space volumes predicts grade ≥ 3 small bowel toxicity in neoadjuvant rectal cancer patients, suggesting the peritoneal space is a reasonable surrogate for contouring individual small bowel loops. However, contouring individual small bowel loops is a more sensitive method for predicting toxicity at each dose increment. For both contouring methods, the greatest sensitivity for predicting toxicity was associated with the volume receiving at least 25 Gy (V25).

scholarly journals Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for clinical node‐negative esophageal carcinoma

2020 ◽  
Vol 11 (9) ◽  
pp. 2618-2629
Author(s):  
Hui‐Jiang Gao ◽  
Yu‐Cheng Wei ◽  
Lei Gong ◽  
Nan Ge ◽  
Bin Han ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Neoadjuvant Chemoradiotherapy ◽  
Node Negative

Relationship between Eustachian tube dysfunction and otitis media with effusion in radiotherapy patients

2018 ◽  
Vol 132 (2) ◽  
pp. 111-116 ◽  
Author(s):  
K Akazawa ◽  
H Doi ◽  
S Ohta ◽  
T Terada ◽  
M Fujiwara ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Intensity Modulated Radiotherapy ◽  
Eustachian Tube Dysfunction ◽  
Dose Volume ◽  
Tube Dysfunction ◽  
The Relationship ◽  
Higher Doses

AbstractObjective:This study evaluated the relationship between radiation and Eustachian tube dysfunction, and examined the radiation dose required to induce otitis media with effusion.Methods:The function of 36 Eustachian tubes in 18 patients with head and neck cancer were examined sonotubometrically before, during, and 1, 2 and 3 months after, intensity-modulated radiotherapy. Patients with an increase of 5 dB or less in sound pressure level (dB) during swallowing were categorised as being in the dysfunction group. Additionally, radiation dose distributions were assessed in all Eustachian tubes using three dose–volume histogram parameters.Results:Twenty-two of 25 normally functioning Eustachian tubes before radiotherapy (88.0 per cent) shifted to the dysfunction group after therapy. All ears that developed otitis media with effusion belonged to the dysfunction group. The radiation dose threshold evaluation revealed that ears with otitis media with effusion received significantly higher doses to the Eustachian tubes.Conclusion:The results indicate a relationship between radiation dose and Eustachian tube dysfunction and otitis media with effusion.

scholarly journals Efficacy of Endoscopic Vacuum-Assisted Closure Treatment for Postoperative Anastomotic Leak in Gastric Cancer

Gut and Liver ◽  
2020 ◽  
Vol 14 (6) ◽  
pp. 746-754
Author(s):  
Soo In Choi ◽  
Jun Chul Park ◽  
Da Hyun Jung ◽  
Sung Kwan Shin ◽  
Sang Kil Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leak ◽  
Vacuum Assisted Closure ◽  
Postoperative Anastomotic Leak

scholarly journals Radiation dose and pathological response in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery: a multi-institutional analysis

2019 ◽  
Vol 58 (10) ◽  
pp. 1358-1365 ◽  
Author(s):  
Melissa Thomas ◽  
Alicia S. Borggreve ◽  
Peter S. N. van Rossum ◽  
Christiaan Perneel ◽  
Johnny Moons ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Patients ◽  
Oesophageal Cancer ◽  
Institutional Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pathological Response

Stenosis of the celiac trunk is associated with anastomotic leak after Ivor–Lewis esophagectomy

2019 ◽  
Vol 32 (7) ◽  
Author(s):  
S Brinkmann ◽  
D H Chang ◽  
K Kuhr ◽  
A H Hoelscher ◽  
J Spiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Anastomotic Leak ◽  
Preoperative Staging ◽  
Multivariable Analysis ◽  
Celiac Trunk ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Significant Difference ◽  
Postoperative Anastomotic Leak

SUMMARY Transthoracic esophagectomy with gastric tube formation is the surgical treatment of choice for esophageal cancer. The surgical reconstruction induces changes of gastric microcirculation, which are recognized as potential risk factors of anastomotic leak. This prospective observational study investigates the association of celiac trunk (TC) stenosis with postoperative anastomotic leak. One hundred fifty-four consecutive patients with esophageal cancer scheduled for Ivor–Lewis esophagectomy were included. Preoperative staging computed tomography (CT) was used to identify TC stenosis. Any narrowing of the lumen due to atherosclerotic changes was classified as stenosis. Percentage of stenotic changes was calculated using the North American Symptomatic Carotid Endarterectomy Trial formula. Multivariable analysis was used to identify possible risk factors for leak. The overall incidence of TC stenosis was 40.9%. Anastomotic leak was identified in 15 patients (9.7%). Incidence of anastomotic leak in patients with stenosis was 19.4% compared to 2.3% in patients without stenosis. Incidence of stenosis in patients with leak was 86.7% (13 of 15 patients) and significantly higher than 38.8% (54 of 139 patients) in patients without leak (P < 0.001). There was a significant difference in median degree of TC stenosis (50.0% vs 39.4%; P = 0.032) in patients with and without leak. In the multivariable model, TC stenosis was an independent risk factor for anastomotic leak (odds ratio: 5.98, 95% CI: 1.58–22.61). TC stenosis is associated with postoperative anastomotic leak after Ivor–Lewis esophagectomy. Routine assessment of TC for possible stenosis is recommended to identify patients at risk.

Sign in / Sign up

Export Citation Format

Share Document