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The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer

INTRODUCTION: Standard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation...

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Autores principales: Kundel, Yulia, Kurman, Noga, Sulimani, Omri, Gavrielli, Shlomo, Nachalon, Yuval, Moore, Assaf, Kashtan, Hanoch, Fenig, Eyal, Brenner, Baruch, Popovtzer, Aron, Fredman, Elisha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011689/
https://www.ncbi.nlm.nih.gov/pubmed/36925923
http://dx.doi.org/10.3389/fonc.2023.1080089
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author Kundel, Yulia
Kurman, Noga
Sulimani, Omri
Gavrielli, Shlomo
Nachalon, Yuval
Moore, Assaf
Kashtan, Hanoch
Fenig, Eyal
Brenner, Baruch
Popovtzer, Aron
Fredman, Elisha
author_facet Kundel, Yulia
Kurman, Noga
Sulimani, Omri
Gavrielli, Shlomo
Nachalon, Yuval
Moore, Assaf
Kashtan, Hanoch
Fenig, Eyal
Brenner, Baruch
Popovtzer, Aron
Fredman, Elisha
author_sort Kundel, Yulia
collection PubMed
description INTRODUCTION: Standard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation dose exposure had been inconclusive. We examined the correlation between radiation exposure to the gastric fundus and risk of postoperative leakage using contemporary radiation doses and fractionation. METHODS: A total of 69 consecutive patients with LAEC who underwent neoadjuvant chemoradiotherapy followed by esophagectomy in our tertiary center were prospectively followed (median, 27 months). Neoadjuvant regimen included 50.4 Gy in 28 fractions with 5-fluorouracil and cisplatin and 41.4 Gy in 23 fractions with carboplatin and paclitaxel. The gastric fundus was contoured and dosimetric and radiation technique parameters were retrospectively evaluated. RESULTS: Of the total number of patients, 71% and 29% had esophageal and gastroesophageal junction (GEJ) tumors, respectively. Fourteen patients (20.3%) experienced anastomotic leaks within a median of 2 days postoperatively, 78.6% of whom had lower third esophagus or GEJ primaries. Mean and minimum fundus dose did not significantly differ between those with and those without leakage (p = 0.42, p = 0.51). Mean fundus V25, V30, and V35 doses were numerically but not statistically higher in those with anastomotic leak (p = 0.58, p = 0.39, and p = 0.30, respectively). No correlation with incidence of leakage was seen between 3D and IMRT treatment modalities. CONCLUSIONS: In our comparatively large prospectively collected series of patients treated for LAEC, radiation dose to the gastric fundus during neoadjuvant combination therapy prior to surgery did not correlate with the risk of postoperative anastomotic leak.
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spelling pubmed-100116892023-03-15 The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer Kundel, Yulia Kurman, Noga Sulimani, Omri Gavrielli, Shlomo Nachalon, Yuval Moore, Assaf Kashtan, Hanoch Fenig, Eyal Brenner, Baruch Popovtzer, Aron Fredman, Elisha Front Oncol Oncology INTRODUCTION: Standard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation dose exposure had been inconclusive. We examined the correlation between radiation exposure to the gastric fundus and risk of postoperative leakage using contemporary radiation doses and fractionation. METHODS: A total of 69 consecutive patients with LAEC who underwent neoadjuvant chemoradiotherapy followed by esophagectomy in our tertiary center were prospectively followed (median, 27 months). Neoadjuvant regimen included 50.4 Gy in 28 fractions with 5-fluorouracil and cisplatin and 41.4 Gy in 23 fractions with carboplatin and paclitaxel. The gastric fundus was contoured and dosimetric and radiation technique parameters were retrospectively evaluated. RESULTS: Of the total number of patients, 71% and 29% had esophageal and gastroesophageal junction (GEJ) tumors, respectively. Fourteen patients (20.3%) experienced anastomotic leaks within a median of 2 days postoperatively, 78.6% of whom had lower third esophagus or GEJ primaries. Mean and minimum fundus dose did not significantly differ between those with and those without leakage (p = 0.42, p = 0.51). Mean fundus V25, V30, and V35 doses were numerically but not statistically higher in those with anastomotic leak (p = 0.58, p = 0.39, and p = 0.30, respectively). No correlation with incidence of leakage was seen between 3D and IMRT treatment modalities. CONCLUSIONS: In our comparatively large prospectively collected series of patients treated for LAEC, radiation dose to the gastric fundus during neoadjuvant combination therapy prior to surgery did not correlate with the risk of postoperative anastomotic leak. Frontiers Media S.A. 2023-02-28 /pmc/articles/PMC10011689/ /pubmed/36925923 http://dx.doi.org/10.3389/fonc.2023.1080089 Text en Copyright © 2023 Kundel, Kurman, Sulimani, Gavrielli, Nachalon, Moore, Kashtan, Fenig, Brenner, Popovtzer and Fredman https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Kundel, Yulia
Kurman, Noga
Sulimani, Omri
Gavrielli, Shlomo
Nachalon, Yuval
Moore, Assaf
Kashtan, Hanoch
Fenig, Eyal
Brenner, Baruch
Popovtzer, Aron
Fredman, Elisha
The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
title The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
title_full The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
title_fullStr The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
title_full_unstemmed The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
title_short The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
title_sort effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011689/
https://www.ncbi.nlm.nih.gov/pubmed/36925923
http://dx.doi.org/10.3389/fonc.2023.1080089
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