AUTHOR=Kastelowitz Noah , Marsh Megan D. , McCarter Martin , Meguid Robert A. , Bhardwaj Narine Wandrey , Mitchell John D. , Weyant Michael J. , Scott Christopher , Schefter Tracey , Stumpf Priscilla , Leong Stephen , Messersmith Wells , Lieu Christopher , Leal Alexis D. , Davis S. Lindsey , Purcell William T. , Kane Madeleine , Wani Sachin , Shah Raj , Hammad Hazem , Edmundowicz Steven , Goodman Karyn A.
TITLE=Impact of Radiation Dose on Postoperative Complications in Esophageal and Gastroesophageal Junction Cancers
JOURNAL=Frontiers in Oncology
VOLUME=11
YEAR=2021
URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.614640
DOI=10.3389/fonc.2021.614640
ISSN=2234-943X
ABSTRACT=Introduction: The impact of radiation prescription dose on postoperative complications during standard of care trimodality therapy for operable stage II-III esophageal and gastroesophageal junction cancers has not been established.
Methods: We retrospectively reviewed 82 patients with esophageal or gastroesophageal junction cancers treated between 2004 and 2016 with neoadjuvant chemoradiation followed by resection at a single institution. Post-operative complications within 30 days were reviewed and scored using the Comprehensive Complication Index (CCI). Results were compared between patients treated with <50 Gy and ≥ 50 Gy, as well as to published CROSS study neoadjuvant chemoradiation group data (41.4 Gy).
Results: Twenty-nine patients were treated with <50 Gy (range 39.6–46.8 Gy) and 53 patients were treated with ≥ 50 Gy (range 50.0–52.5 Gy) delivered using IMRT/VMAT (41%), 3D-CRT (46%), or tomotherapy IMRT (12%). Complication rates and CCI scores between our <50 Gy and ≥ 50 Gy groups were not significantly different. Assuming a normal distribution of the CROSS data, there was no significant difference in CCI scores between the CROSS study neoadjuvant chemoradiation, <50 Gy, or ≥ 50 Gy groups. Rates of pulmonary complications were greater in the CROSS group (50%) than our <50 Gy (38%) or ≥ 50 Gy (30%) groups.
Conclusions: In selected esophageal and gastroesophageal junction cancer patients, radiation doses ≥ 50 Gy do not appear to increase 30 day post-operative complication rates. These findings suggest that the use of definitive doses of radiotherapy (50–50.4 Gy) in the neoadjuvant setting may not increase post-operative complications.