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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
AbstractObjective 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.
Fund:Beijing Marathon of Hope Foundation (LC2018L03);Capital′s Funds for Health Improvement and Research (2020-1-4021)
Corresponding Authors:
Jin Jing, Email:jinjing@csco.org.cn
Cite this article:
. 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.
. 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.
[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. DOI:10.3322/caac.21338. [2] Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012:a single-institution, high-volume experience in China[J]. Ann Surg, 2016, 263(1):88-95. DOI:10.1097/SLA.0000000000001148. [3] Liu D, Lu M, Li J, et al. The patterns and timing of recurrence after curative resection for gastric cancer in China[J]. World J Surg Oncol, 2016, 14(1):305-316. DOI:10.1186/s12957-016-1042-y. [4] Shapiro J, van Lanschot J, Hulshof M, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS):long-term results of a randomised controlled trial[J]. Lancet Oncol, 2015, 16(9):1090-1098. DOI:10.1016/S1470-2045(15)00040-6. [5] Zhang ZX, Gu XZ, Yin WB, et al. Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of adenocarcinoma of gastric cardia (AGC)—report on 370 patients[J]. Int J Radiat Oncol Biol Phys, 1998, 42(5):929-934. DOI:10.1016/s0360-3016(98)00280-6. [6] Wang J, Lin SH, Dong L, et al. Quantifying the interfractional displacement of the gastroesophageal junction during radiation therapy for esophageal cancer[J]. Int J Radiat Oncol Biol Phys, 2012, 83(2):e273-280. DOI:10.1016/j.ijrobp.2011.12.048. [7] Wang JZ, Li JB, Wang W, et al. Changes in tumour volume and motion during radiotherapy for thoracic oesophageal cancer[J]. Radiother Oncol, 2015, 114(2):201-205. DOI:10.1016/j.radonc.2014.12.010. [8] Watanabe M, Isobe K, Uno T, et al. Intrafractional gastric motion and interfractional stomach deformity using CT images[J]. J Radiat Res, 2011, 52(5):660-665. DOI:10.1269/jrr.11018. [9] van Herk M. Errors and margins in radiotherapy[J]. Semin Radiat Oncol, 2004, 14(1):52-64. DOI:10.1053/j.semradonc.2003.10.003. [10] Liu F, Ng S, Huguet F, et al. Are fiducial markers useful surrogates when using respiratory gating to reduce motion of gastroesophageal junction tumors?[J]. Acta Oncol, 2016, 55(8):1040-1046. DOI:10.3109/0284186X.2016.1167953. [11] Tsai YL, Wu CJ, Shaw S, et al. Quantitative analysis of respiration-induced motion of each liver segment with helical computed tomography and 4-dimensional computed tomography[J]. Radiat Oncol, 2018, 13(1):59. DOI:10.1186/s13014-018-1007-0. [12] Yu ZH, Lin SH, Balter P, et al. A comparison of tumor motion characteristics between early stage and locally advanced stage lung cancers[J]. Radiother Oncol, 2012, 104(1):33-38. DOI:10.1016/j.radonc.2012.04.010. [13] Hashimoto T, Shirato H, Kato M, et al. Real-time monitoring of a digestive tract marker to reduce adverse effects of moving organs at risk (OAR) in radiotherapy for thoracic and abdominal tumors[J]. Int J Radiat Oncol Biol Phys, 2005, 61(5):1559-1564. DOI:10.1016/j.ijrobp.2005.01.006. [14] 唐源,崔伟杰,王鑫,等. 术前放疗中食管胃结合部病灶移动度分析[J]. 中华放射肿瘤学杂志,2017, 26(6):631-635. DOI:10.3760/cma.j.issn.1004-4221.2017.06.005. Tang Y, Cui WJ, Wang X, et al. Motion of gastroesophageal junction adenocarcinoma during preoperative radiotherapy[J]. Chin J Radiat Oncol, 2017, 26(6):631-635. DOI:10.3760/cma.j.issn.1004-4221.2017.06.005. [15] Zhao KL, Liao Z, Bucci MK, et al. Evaluation of respiratory-induced target motion for esophageal tumors at the gastroesophageal junction[J]. Radiother Oncol, 2007, 84(3):283-289. DOI:10.1016/j.radonc.2007.07.008. [16] Wunderink W, Méndez Romero A, de Kruijf W, et al. Reduction of respiratory liver tumor motion by abdominal compression in stereotactic body frame, analyzed by tracking fiducial markers implanted in liver[J]. Int J Radiat Oncol Biol Phys, 2008, 71(3):907-915. DOI:10.1016/j.ijrobp.2008.03.010. [17] Wysocka B, Moseley J, Brock K, et al. Assessment of nonrespiratory stomach motion in healthy volunteers in fasting and postprandial states[J]. Pract Radiat Oncol, 2014, 4(5):288-293. DOI:10.1016/j.prro.2013.10.001. [18] Bouchard M, McAleer MF, Starkschall G. Impact of gastric filling on radiation dose delivered to gastroesophageal junction tumors[J]. Int J Radiat Oncol Biol Phys, 2010, 77(1):292-300. DOI:10.1016/j.ijrobp.2009.08.026. [19] Van De Voorde L, Larue R, Persoon L, et al. The influence of gastric filling instructions on dose delivery in patients with oesophageal cancer:a prospective study[J]. Radiother Oncol, 2015, 117(3):442-447. DOI:10.1016/j.radonc.2015.09.006. [20] Jin P, van der Horst A, de Jong R, et al. Marker-based quantification of interfractional tumor position variation and the use of markers for setup verification in radiation therapy for esophageal cancer[J]. Radiother Oncol, 2015, 117(3):412-418. DOI:10.1016/j.radonc.2015.10.005. [21] Yamashita H, Kida S, Sakumi A, et al. Four-dimensional measurement of the displacement of internal fiducial markers during 320-multislice computed tomography scanning of thoracic esophageal cancer[J]. Int J Radiat Oncol Biol Phys, 2011, 79(2):588-595. DOI:10.1016/j.ijrobp.2010.03.045.
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