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 D_mean, D_max, 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.
Gastrointest Tumors

中文翻译：

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食管癌新辅助放化疗期间胃底放射剂量对术后吻合口漏有影响吗？

背景：新辅助放化疗 (NACRT) 中胃底 (GF) 接受的辐射剂量可能会影响三联疗法治疗可切除食管癌 (EC) 术后吻合口漏 (AL) 的发展。本研究旨在评估 GF 的剂量体积参数及其与 EC 中 AL 发生的关系。材料与方法：回顾性分析 2015 年 1 月至 2018 年 7 月期间接受 NACRT 后行食管切除术和颈食管胃吻合术的 27 例 EC 患者。记录GF的剂量-体积参数。从手术记录中确定术后 AL。逻辑回归分析用于识别与 AL 相关的危险因素。结果：患者的平均年龄为 51 ± 10.5 岁；56% (15/27) 受累于下 1/3 食道、10/27 (37%) 胸中段食道和 2/27 (7%) 上胸段食道；40% (11/27) 患者发生术后 AL，7/11 有远端食管病变，4/11 有胸中段食管病变。接受 3 维适形放射治疗的 5 名患者中有 4 名 (80%) 与接受容积调节弧线治疗的 7/22 (32%) 名患者发生 AL ( p = 0.12)。单变量逻辑回归显示D _mean , D _{max之间没有显着相关性}、V20、V25、V30、V35、D50 和 AL。8/27 例患者接受了胃导管缺血预处理，2/8 患者发生 AL；19/27 未接受预处理，9/19 患者经历 AL（p = 0.4）。结论：在 NACRT 中 GF 接受的剂量对 AL 率没有显着的负面影响。需要更大样本量的进一步研究来澄清这个问题。
胃肠肿瘤