Feasibility of intensity-modulated radiation therapy with concurrent chemotherapy in patients with Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction before surgery
10.3760/cma.j.issn.1004-4221.2017.11.006
- VernacularTitle: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
- Author:
Jun WANG
1
;
Qun ZHAO
;
Xin HUANG
;
Yuan TIAN
;
Yong LI
;
Yi WANG
;
Feng CAO
;
Yunjie CHENG
;
Shaowu JING
Author Information
1. 050011河北医科大学第四医院放疗科
- Keywords:
Esophagogastric junction adenocarcinoma/radiotherapy;
Esophagogastric junction adenocarcinoma/chemotherapy;
Involved-field irradiation;
feasibility
- From:
Chinese Journal of Radiation Oncology
2017;26(11):1269-1275
- CountryChina
- Language:Chinese
-
Abstract:
postoperative pathological examination results and radiotherapy toxicities. Results 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 R0resection 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%(46/1 062). 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-T4tumors 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. Conclusions 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 R0resection 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.
