title: Predictors of postoperative complications after trimodality therapy for esophageal cancer.
abstract: OBJECTIVE
  While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation.
  
  
  METHODS
  From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ(2) or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis.
  
  
  RESULTS
  The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities.
  
  
  CONCLUSIONS
  The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jingya
authors.initials: J
authors.lastname: Wang
authors.forename: Caimiao
authors.initials: C
authors.lastname: Wei
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: Bevan
authors.initials: B
authors.lastname: Myles
authors.forename: Matthew
authors.initials: M
authors.lastname: Palmer
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: James D
authors.initials: JD
authors.lastname: Cox
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000601:surgery / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery / Q000628:therapy*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult