Relationship between gastric filling status and intra-or inter-fractional displacement of tumor in the preoperative radiotherapy of adenocarcinoma of the esophagogastric junction
Shi Jinming1, Liu Wenyang1, Tang Yuan1, Li Ning1, Song Yongwen1, Wang Shulian1, Ren Hua1, Liu Yueping1, Fang Hui1, Lu Ningning1, Tang Yu1, Qi Shunan1, Yang Yong1, Chen Bo1, Li Yexiong1, Jin Jing1,2
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
Abstract：Objective To investigate the relationship between gastric filling status and intra-or inter-fractional tumor displacement in patients with adenocarcinoma of the esophagogastric junction (AEG) undergoing preoperative radiotherapy. Methods From October 2018 to June 2019, 10 patients with locally advanced AEG who received totally neoadjuvant therapy were enrolled in this prospective study. Patients received two markers implanted at the cranial and caudal borders of the tumors under gastroscope and a total of 20 fiducial markers were implanted finally. All patients underwent 4DCT scan under the gastric fasting and filling status. Ten images of 0% to 90% respiratory phase were automatically reconstructed by the system (Pinnacle3,version9.1,Philips Medical Systems,Eindhoven,The Netherland). Each patient obtained one hundred sets of images. Results In the tumors proximal to the chest, gastric filling did not significantly affect intrafractional or interfractional tumor displacements. Nevertheless, in the tumors distal to the chest, the interfractional displacement in the cranio-caudal (CC) direction under the gastric fasting status was significantly larger compared with that under the gastric filling status (6.22±4.67mm vs. 4.13±3.68mm,P=0.013). To ensure 95% of the prescribed dose irradiated to at least 90% of the tumor volume during the radiotherapy, the margins of tumors proximal to the chest in the left-right (LR), antero-posterior (AP) and CC directions were 9mm, 8.5mm, 12.1mm under gastric filling status with 300ml semi-fluid. Six patients diagnosed with gastric cancer with proximal thoracic fiducial markers treated by preoperative radiotherapy were included in the validation group, revealing that the fiducial markers of 93% patients were covered in this margin. Conclusion During the preoperative radiotherapy in AEG patient, the approach of quantitative gastric filling can be considered.
. Relationship between gastric filling status and intra-or inter-fractional displacement of tumor in the preoperative radiotherapy of adenocarcinoma of the esophagogastric junction[J]. Chinese Journal of Radiation Oncology, 2021, 30(8): 792-796.
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