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Effect of neoadjuvant radiation dose on surgical and oncological outcome in locally advanced esophageal cancer

ELKE VAN DAELE (UGent) , Wim Ceelen (UGent) , Tom Boterberg (UGent) , Oswald Varin (UGent) , Yves Van Nieuwenhove (UGent) , Dirk Van de Putte (UGent) , Karen Geboes (UGent) and Piet Pattyn (UGent)
(2015) ACTA CHIRURGICA BELGICA. 115(1). p.8-14
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Abstract
Introduction : Neoadjuvant chemoradiation (CRT) confers a survival benefit in locally advanced esophageal cancer. The optimal dose of radiotherapy remains undefined. Methods : From a prospective database, we identified patients who received CRT followed by Ivor Lewis esophagectomy. Surgical complications, pathological response, and oncological outcome were compared between patients who received a radiotherapy (RT) dose of 36 Gy (group 1) versus a dose of >40 Gy (group 2). Results : 147 patients were evaluated : 109 received 36 Gy, while 38 received 41-50Gy. Mean age was 61 +/- 9 years (84% male). Median hospital stay was 16 days. Anastomotic leakage occurred in 4.0%. Pulmonary complications occurred in 41.8%, neither being influenced by RT dose. Complete resection (RO) was achieved in 95% (group 1) and 100% (group 2), P = 0.3. Pathological complete response (pCR) was observed in 19% (group 1) and 37% (group 2), P = 0.04. Local recurrence developed in 9% in group 1, and 3% in group 2 (P = 0.3), but regional recurrence developed significantly higher in the low dose group (28% vs 3%, P < 0.001). Metastatic recurrence occurred in 48% in group 1 and 13% in group 2 (P < 0.001). Conclusions : In patients with locally advanced esophageal cancer a higher RT dose does not affect surgical outcome, enhances pCR rate, and reduces the locoregional and metastatic recurrence risk.
Keywords
PREOPERATIVE CHEMORADIOTHERAPY, POSTOPERATIVE PULMONARY COMPLICATIONS, CONCURRENT CHEMORADIOTHERAPY, RISK, RADIOCHEMOTHERAPY, CHEMORADIATION, ADENOCARCINOMA, CARCINOMA, PROGNOSIS, MORTALITY

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MLA
VAN DAELE, ELKE et al. “Effect of Neoadjuvant Radiation Dose on Surgical and Oncological Outcome in Locally Advanced Esophageal Cancer.” ACTA CHIRURGICA BELGICA 115.1 (2015): 8–14. Print.
APA
VAN DAELE, E., Ceelen, W., Boterberg, T., Varin, O., Van Nieuwenhove, Y., Van de Putte, D., Geboes, K., et al. (2015). Effect of neoadjuvant radiation dose on surgical and oncological outcome in locally advanced esophageal cancer. ACTA CHIRURGICA BELGICA, 115(1), 8–14.
Chicago author-date
VAN DAELE, ELKE, Wim Ceelen, Tom Boterberg, Oswald Varin, Yves Van Nieuwenhove, Dirk Van de Putte, Karen Geboes, and Piet Pattyn. 2015. “Effect of Neoadjuvant Radiation Dose on Surgical and Oncological Outcome in Locally Advanced Esophageal Cancer.” Acta Chirurgica Belgica 115 (1): 8–14.
Chicago author-date (all authors)
VAN DAELE, ELKE, Wim Ceelen, Tom Boterberg, Oswald Varin, Yves Van Nieuwenhove, Dirk Van de Putte, Karen Geboes, and Piet Pattyn. 2015. “Effect of Neoadjuvant Radiation Dose on Surgical and Oncological Outcome in Locally Advanced Esophageal Cancer.” Acta Chirurgica Belgica 115 (1): 8–14.
Vancouver
1.
VAN DAELE E, Ceelen W, Boterberg T, Varin O, Van Nieuwenhove Y, Van de Putte D, et al. Effect of neoadjuvant radiation dose on surgical and oncological outcome in locally advanced esophageal cancer. ACTA CHIRURGICA BELGICA. 2015;115(1):8–14.
IEEE
[1]
E. VAN DAELE et al., “Effect of neoadjuvant radiation dose on surgical and oncological outcome in locally advanced esophageal cancer,” ACTA CHIRURGICA BELGICA, vol. 115, no. 1, pp. 8–14, 2015.
@article{5958262,
  abstract     = {Introduction : Neoadjuvant chemoradiation (CRT) confers a survival benefit in locally advanced esophageal cancer. The optimal dose of radiotherapy remains undefined.
Methods : From a prospective database, we identified patients who received CRT followed by Ivor Lewis esophagectomy. Surgical complications, pathological response, and oncological outcome were compared between patients who received a radiotherapy (RT) dose of 36 Gy (group 1) versus a dose of >40 Gy (group 2).
Results : 147 patients were evaluated : 109 received 36 Gy, while 38 received 41-50Gy. Mean age was 61 +/- 9 years (84% male). Median hospital stay was 16 days. Anastomotic leakage occurred in 4.0%. Pulmonary complications occurred in 41.8%, neither being influenced by RT dose. Complete resection (RO) was achieved in 95% (group 1) and 100% (group 2), P = 0.3. Pathological complete response (pCR) was observed in 19% (group 1) and 37% (group 2), P = 0.04. Local recurrence developed in 9% in group 1, and 3% in group 2 (P = 0.3), but regional recurrence developed significantly higher in the low dose group (28% vs 3%, P < 0.001). Metastatic recurrence occurred in 48% in group 1 and 13% in group 2 (P < 0.001).
Conclusions : In patients with locally advanced esophageal cancer a higher RT dose does not affect surgical outcome, enhances pCR rate, and reduces the locoregional and metastatic recurrence risk.},
  author       = {VAN DAELE, ELKE and Ceelen, Wim and Boterberg, Tom and Varin, Oswald and Van Nieuwenhove, Yves and Van de Putte, Dirk and Geboes, Karen and Pattyn, Piet},
  issn         = {0001-5458},
  journal      = {ACTA CHIRURGICA BELGICA},
  keywords     = {PREOPERATIVE CHEMORADIOTHERAPY,POSTOPERATIVE PULMONARY COMPLICATIONS,CONCURRENT CHEMORADIOTHERAPY,RISK,RADIOCHEMOTHERAPY,CHEMORADIATION,ADENOCARCINOMA,CARCINOMA,PROGNOSIS,MORTALITY},
  language     = {eng},
  number       = {1},
  pages        = {8--14},
  title        = {Effect of neoadjuvant radiation dose on surgical and oncological outcome in locally advanced esophageal cancer},
  volume       = {115},
  year         = {2015},
}

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