221: Radiation Dose Mapping of the Stomach in Trimodality Therapy for Esophageal Cancer
Notice bibliographique
Résumé
Purpose: Esophageal cancer remains a difficult cancer to cure despite aggressive therapy. A common strategy aimed at achieving cure in locally advanced esophageal cancers is to use neoadjuvant concurrent chemoradiotherapy followed by surgery ("trimodality" therapy). Post-operative complications following esophagectomy with gastric pull-up are significant events when they occur, including possible anastomotic leaks. Our goal is to investigate whether a relationship exists between these complications and radiation dose to either anastomotic end (proximal esophageal and distal gastric). For this purpose, we present dosimetric data describing the planned dose to different parts of the stomach with specific attention paid to the distal 2/3 of the organ which is most commonly used to form the gastro-esophageal anastomosis. Methods and Materials: An ethics board-approved retrospective analysis was performed on 37 consecutive patients at our institute who underwent neoadjuvant chemoradiotherapy followed by a radical esophagectomy. Patients were treated between January 1, 2008 and December 31, 2012. For each case, the 3D conformal plan was re-calculated once the stomach was contoured. Gastric contouring consisted of an overall organ contour from the gastro-esophageal junction to the pylorus. A series of sub-contours were then devised dividing the stomach into thirds: superior, middle and inferior third. The superior third was further subdivided into medial and lateral sub-components. At the time of simulation, patients were not given any specific instructions for food avoidance, and a subset were asked to drink oral contrast (< 100 ml). The mean radiation dose and V40 were computed for specified regions of the stomach. Results: A total of 37 patients were analyzed. The study cohort included 31 cases of esophageal adenocarcinoma and six cases of squamous cell carcinoma. Thirty-five of 37 cases involved the lower third of the esophagus. All surgeries were performed with a transthoracic approach, with minimally invasive ( Radiation dose varied between 4500-5040 cGy, given 180-200 cGy per day, often with a two phase approach with a smaller boost volume. The mean (range) dose of the medial superior, lateral superior, middle and inferior thirds of the stomach were 3919 cGy (46-5193), 2587 cGy (40-5077), 2569 cGy (27-4713) and 1304 cGy (14-4265) respectively. The calculated V40 for each gastric sub-segment was 72.3%, 34.0%, 34.7% and 12.5% respectively. Conclusions: There is no radiation sparing of the distal 2/3 of the stomach in patients treated with neoadjuvant radiotherapy for esophageal cancer. In some cases, doses approach or are equal to the prescribed dose. Surgeons may not be aware that tissues used to form an anastomosis with the proximal esophagus may have received significant dose. There is rationale to investigate a relationship between dose to the stomach and potential anastomotic complications in this patient population.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».