SiewertⅡ、Ⅲ型食管胃结合部腺癌术前受累野照射同期化疗可行性分析

doi:10.3760/cma.j.issn.1004-4221.2017.11.006

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Abstract

Objective To analyze the feasibility of intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy in patients with locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods A prospective study was performed on 45 patients with locally advanced Siewert type Ⅱ and Ⅲ AEG. These patients received two cycles of XELOX chemotherapy and concurrent IMRT to the involved field (45 Gy/25 f, 5 f/week) for 6 to 8 weeks before surgical resection. The patients ingested 800 to 1000 ml water to distend the stomach before computed tomography (CT) scan. The gross tumor volume of the primary tumor (GTV-t) was delineated on the CT image with a stomach wall thickness of>5 mm. GTV-t was expanded by a 2.0 cm margin along the esophagus, a 1.5-2.0 cm margin along the stomach, and a 0.8 cm margin axially outward to generate the clinical target volume of the primary tumor (CTV-t). GTV-lymph node (GTV-nd) was delineated based on CT/magnetic resonance imaging scan. CTV-nd only included GTV-nd and the involved lymph nodes. Planning target volume was generated by expanding the CTV by 0.8 to 1.0 cm. The feasibility of target volume delineation was explored by analyzing postoperative pathological examination Resutls and radiotherapy toxicities. Resutls All the 45 patients completed preoperative concurrent chemoradiotherapy and surgery, with two cycles of chemotherapy in 39 patients and one cycle in 6 patients. The rates of R0 resection and pathological complete response (pCR) were 95.6%(43/45) and 22.2%(10/45), respectively. There were 10(22.2%), 17(37.8%), 15(33.3%), and 3(6.7%) patients with tumor regression grades 0, 1, 2, 3, respectively. The rate of lymph node metastasis was 37.8%(17/45), and the lymph node ratio was 4.33%(46/1062). The postoperative pathological examination showed that T and N downstaging after surgery was observed in 24 and 26 patients, respectively;the proportions of patients with T3-T4 tumors and positive lymph nodes after surgery declined by 51.1%(P=0.000) and 42.2%(P=0.000), respectively. The overall incidence of radiation esophagitis/gastritis was 44.4%(20/45), and the incidence rates of grade 1, 2, and 3 radiation esophagitis/gastritis were 18%, 22%, and 4%, respectively. The incidence of acute radiation pneumonitis was 6.7%(3/45), all in grades 1 and 2. There was one perioperative treatment-related death. Conclutions Two cycles of XELOX chemotherapy combined with concurrent 45 Gy radiotherapy before surgery in patients with locally advanced Siewert type Ⅱ and Ⅲ AEG can achieve a relatively high pCR rate, effectively reduce the lymph node metastasis rate, achieve downstaging, and increase R0 resection rate. This regimen has many good advantages, including low incidence of acute toxicities, good tolerability, and acceptable rate of perioperative treatment-related deaths. The target volume delineation involving metastatic lymph nodes is feasible.

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	Articles by authors
	Wang Jun
	Zhao Qun
	Huang Xin
	Tian Yuan
	Li Yong
	Wang Yi
	Cao Feng
	Cheng Yunjie
	Jing Shaowu

Key words： Esophagogastric junction adenocarcinoma/radiotherapy Esophagogastric junction adenocarcinoma/chemotherapy Involved-field irradiation,feasibility

Received: 24 February 2017

Cite this article:

Wang Jun,Zhao Qun,Huang Xin et al. Feasibility of intensity-modulated radiation therapy with concurrent chemotherapy in patients with Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction before surgery[J]. Chinese Journal of Radiation Oncology, 2017, 26(11): 1269-1275.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.11.006 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I11/1269

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