胃癌术前放化疗正常组织放射损伤的剂量效应分析

doi:10.3760/cma.j.issn.1004-4221.2018.03.009

Abstract
Figure/Table
References()
Related Citation (2)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract

Objective To investigate the clinical and dose-volume factors for damages to organs at risk (OARs) during preoperative chemoradiotherapy for gastric cancer, and to provide a reference for optimization of radiotherapy plans to avoid or reduce damages to OARs. Methods A total of 58 patients with locally advanced gastric adenocarcinoma undergoing neoadjuvant treatment were enrolled as subjects. In those patients, 30 received preoperative chemoradiotherapy combined with surgery and adjuvant chemotherapy, while others received preoperative chemotherapy combined with surgery and adjuvant chemotherapy. The preoperative chemotherapy group received 2-3 cycles of xeloxregimen (capecitabine+oxaliplatin) before surgery and 3-4 cycles of xeloxregimen after surgery (a total of 6 cycles). The preoperative chemoradiotherapy group received preoperative radiotherapy (45 Gy in 25 fractions) combined with 2 cycles of concurrent xeloxchemotherapy at 14-21 days after the first cycle of xeloxregimen, as well as 3 cycles of xeloxchemotherapy after surgery. The analyses of clinical and dose-volume factors for damages to OARs were performed based on laboratory indices and clinical symptoms during the treatment. Results In all the patients, the incidence rates of liver injury (LI), renal injury (RI), and duodenum injury (DI) before surgery were 22%,48%, and 33%, respectively;the incidence rates of LI and RI after treatment were 35% and 49%, respectively. After appropriate treatment, neither LI nor DI affected the treatment of gastric cancer. RI healed without any special treatment. Compared with preoperative chemotherapy, preoperative chemoradiotherapy caused higher incidence of LI (P=0.00,0.03).RI was only associated with glomerular filtration rate before radiotherapy (P=0.08,0.13). A V3.5 of ≤98.96% for the liver reduced LI, while a D2cc of ≤48 Gy for the duodenum reduced DI. Conclusions Preoperative chemoradiotherapy is safe for treating gastric cancer. Compared with preoperative chemotherapy, preoperative chemoradiotherapy does not increase the risk of RI. However,preoperative chemoradiotherapy tends to increase LI.Further studies are needed to improve the treatment method.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Feng Lingling
	Zhang Yujing
	Zhang Li
	Huang Shaomin
	Zhou Zhiwei

Key words： Gastric neoplasms/preoperative chemoradiotherapy Gastric neoplasms/three-dimentional radiotherapy Injury of normal tissue Dose-effect

Received: 13 June 2017

Fund:

5010 Program of Clinical Research of Sun Yat-sen University (2012013)

Corresponding Authors: Zhang Yujing,Email:zhangyj@sysucc.org.cn

Cite this article:

Feng Lingling,Zhang Yujing,Zhang Li et al. A dose-effect analysis of organs at risk during preoperative chemoradiotherapy for gastric cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(3): 271-276.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2018.03.009 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2018/V27/I3/271

[1] Ajani JA,Rodriguez W,Bodoky G,et al. Multicenter phase Ⅲ comparison of cisplatin/S-1 with cisplatin/infusional fluorouracil in advanced gastric or gastroesophageal adenocarcinoma study:the FLAGS trial[J].J ClinOncol,2010,28(9):1547-1553.DOI:10.1200/JCO.2009.25.4706.
[2] Koizumi W,Narahara H,Hara T,et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastriccancer (SPIRITS trial):a phase Ⅲ trial[J].Lancet Oncol,2008,9(3):215-221.DOI:10.1016/S1470-2045(08)70035-4.
[3] Trip AK,Poppema BJ,Van Berge MI,et al. Preoperative chemoradiotherapy in locally advanced gastric cancer,a phase Ⅰ/Ⅱ feasibility and efficacy study[J].RadiotherOncol,2014,112(2):284-288.DOI:10.1016/j.radonc.2014.05.003.
[4] Pera M,Gallego R,Montagut C,et al. Phase Ⅱ trial of preoperative chemoradiotherapy with oxaliplatin,cisplatin,and 5-FU in locally advanced esophageal and gastric cancer[J].Ann Oncol,2012,23(3):664-670.DOI:10.1093/annonc/mdr291.
[5] Leong T,Smithers BM,Haustermans K,et al. TOPGEAR:arandomized,phase Ⅲ trial of perioperative ECF chemotherapy with or without preoperative chemoradiation for resectable gastric cancer:interim results from an international,intergroup trial of the AGITG,TROG,EORTC and CCTG[J].Ann SurgOncol,2017,24(8):2252-2258.DOI:10.1245/s10434-017-5830-6.
[6] Macdonald JS,Smalley SR,Benedetti J,et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J].N Engl J Med,2001,345(10):725-730.DOI:10.1056/NEJMoa010187.
[7] NCCN. NCCN clinical practice guidelines in oncology,antiemesis,(version1.2017)[M].NCCN,2017.
[8] Matzinger O,Gerber E,Bernstein Z,et al. EORTC-ROG expert opinion:radiotherapy volume and treatment guidelines for neoadjuvant radiation of adenocarcinomas of the gastroesophageal junction and the stomach[J].RadiotherOncol,2009,92(2):164-175.DOI:10.1016/j.radonc.2009.03.018.
[9] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-S266.
[10] Chakravarty T,Crane CH,Ajani JA,et al. Intensity-modulated radiation therapy with concurrent chemotherapy as preoperative treatment for localized gastric adenocarcinoma[J].Int J RadiatOncolBiolPhys,2012,83(2):581-586.DOI:10.1016/j.ijrobp.2011.07.035.
[11] Li GC,Wang JZ,Hu WG,et al. Radiation-induced liver injury in three-dimensional conformal radiation therapy (3D-CRT) for postoperative or locoregional recurrent gastric cancer:risk factors and dose limitations[J/OL].PLoS One,2015,10(8):e0136288.DOI:10.1371/journal.pone.0136288.
[12] Liang SX,Zhu XD,Xu ZY,et al. Radiation-induced liver disease in three-dimensional conformal radiation therapyfor primary liver carcinoma:the risk factors and hepatic radiation tolerance[J].Int J RadiatOncolBiolPhys,2006,65(2):426-434.DOI:10.1016/j.ijrobp.2005.12.031.
[13] Kawashima M,Kohno R,Nakachi K,et al. Dose-volume histogram analysis of the safety of proton beam therapy for unresectable hepatocellular carcinoma[J].Int J RadiatOncolBiol Phys,2011,79(5):1479-1486.DOI:10.1016/j.ijrobp.2009.12.048.
[14] Yavas G,Elsurer R,Yavas C,et al. Basal renal function reserve and mean kidney dose predict future radiation-induced kidney injury in stomach cancer patients[J].Support Care Cancer,2014,22(2):445-451.DOI:10.1007/s00520-013-1996-z.
[15] Feehally JF,Floege J.Comprehensive clinicalnephrology[M].3rd ed. Philadelphia,PA:Mosby/Elsevier,2007:27-34.
[16] Trip AK,Nijkamp J,Van Tinteren H,et al. IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer[J].RadiotherOncol,2014,112(2):289-294.DOI:10.1016/j.radonc.2014.08.039.
[17] Diavolitsis VM,Rademaker A,Boyle J,et al. Change in creatinine clearance over time following upper abdominal irradiation:a dose-volume histogram multivariate analysis[J].Am J ClinOncol,2011,34(1):53-57.DOI:10.1097/COC.0b013e3181 d27080.
[18] Jansen EPM,Saunders MP,Boot H,et al. Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer[J].Int J RadiatOncolBiolPhys,2007,67(3):781-785.DOI:10.1016/j.ijrobp.2006.09.012.
[19] K st S,D rr W,Keinert K,et al. Effect of dose and dose-distribution in damage to the kidney following abdominalradiotherapy[J].Int J RadiatBiol,2002,78(8):695-702.DOI:10.1080/09553000210134791.
[20] Minn AY,Hsu A,La T,et al. Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer[J].Cancer,2010,116(16):3943-3952.DOI:10.1002/cncr.25246.
[21] Chon YE,Seong J,Kim BK,et al. Gastroduodenal complications after concurrent chemoradiation therapy in patients with hepatocellular carcinoma:endoscopic findings and risk factors[J].Int J Radiat OncolBiolPhys,2011,81(5):1343-1351.DOI:10.1016/j.ijrobp.2010.07.1986.
[22] Prior P,Tai A,Erickson B,et al. Consolidating duodenal and small bowel toxicity data via isoeffective dose calculations based on compiled clinical data[J].PractRadiatOncol,2014,4(2):e125-e131.DOI:10.1016/j.prro.2013.05.003.
[23] Shinoto M,Shioyama Y,Matsunobu A,et al. Dosimetric analysis of upper gastrointestinal ulcer after carbon-ion radiotherapy for pancreatic cancer[J].RadiotherOncol,2016,120(1):140-144.DOI:10.1016/j.radonc.2016.04.040