Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant
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RESEARCH
Open Access
Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation and transhiatal esophagectomy Marijn Koëter1, Maurice JC van der Sangen2, Coen W Hurkmans2, Misha DP Luyer1, Harm JT Rutten1 and Grard AP Nieuwenhuijzen1*
Abstract Background: Neoadjuvant chemoradiation might increase anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. The aim of this study was to determine the influence of radiation dose on the incidence of leakage and stenosis. Methods: Fifty-three patients with esophageal cancer received neoadjuvant chemoradiation (23 × 1.8 Gy) (combined with Paclitaxel and Carboplatin) followed by a transhiatal esophagectomy between 2009 and 2011. On planning CT, the future anastomotic region was determined and the mean radiation dose, V20, V25, V30, V35 and V40 were calculated. Logistic regression analysis was conducted to examine determinants of anastomotic leakage and stenosis. Results: Anastomotic leaks occurred in 13 of 53 patients (25.5%) and anastomotic stenosis occurred in 24 of 53 patients (45.3%). Median follow-up was 20 months. Logistic regression analysis showed that mean dose, V20-V40, age, co-morbidity, method of anastomosis, operating time and interval between last radiotherapy treatment and surgery were not predictors of anastomotic leakage and stenosis. Conclusions: A radiation dose of 23 × 1.8 Gy on the future anastomotic region has no influence on the occurrence of anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by transhiatal esophagectomy. Keywords: Radiation dose, Anastomotic complications, Esophageal cancer
Background Esophageal cancer is the eighth most commonly diagnosed type of cancer worldwide and it is the sixth leading cause of cancer deaths [1]. The incidence of esophageal carcinoma in the Netherlands, especially adenocarcinoma, has rapidly risen from 1731 new cases in 2000 to 2499 in 2010 [2]. According to the current Dutch guidelines, the preferred curative treatment for non-metastatic disease is neoadjuvant chemoradiation followed by transhiatal or transthoracic esophagectomy [3]. Patients with an irresectable tumor, or patients who are too vulnerable * Correspondence: [email protected] 1 Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands Full list of author information is available at the end of the article
for surgery are often proposed for definitive chemoradiation which show encouraging results [4,5]. Surgical treatment has an acceptable mortality in high volume centres, but high rates of post-operative morbidity have still been described [6-9]. However, pulmonary complications and anastomotic complications like leakage and stenosis are still common [7-9]. The incidence of anastomotic leakage reported in the literature ranges from 5.7% to 41% [6-16]. Incidence r
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