title: Comparison of locoregional versus extended locoregional radiation volumes for patients with nonmetastatic gastro-esophageal junction carcinomas.
abstract: BACKGROUND
  To delineate an optimal clinical target volume (CTV) for gastroesophageal junction (GEJ) cancers by comparing locoregional versus extended locoregional radiation (RT) volumes.
  
  
  METHODS
  This retrospective analysis examined 222 patients (111 matched pairs treated with locoregional versus extended locoregional RT) with nonmetastatic GEJ carcinomas treated with concurrent chemoradiation ± surgery. The CTV for locoregional volumes was defined as gross tumor volume + elective coverage of first-echelon nodes and sometimes the celiac axis. The CTV for extended locoregional volumes was defined as gross tumor volume + elective coverage of celiac and splenic (± porta) nodes. Variables used for matching included sex, stage, performance status, histology, receipt of induction chemotherapy, type of concurrent chemotherapy, RT modality, receipt of surgery, type of surgery, and Siewert classification. Regression models stratified by matched pairs were fit to estimate effect of RT volume on clinical endpoints.
  
  
  RESULTS
  Adjusting p values for multiple testing, patients treated with extended locoregional versus locoregional RT had increased odds of grade 2+ acute chemoradiation-associated gastrointestinal toxicity (odds ratio: 2.92, adj. p = 0.0447). However, differing RT volumes were not significantly associated with postoperative complication rates, pathologic T-stage, frequency of positive perigastric/regional nodes on surgical specimen, distant-metastases progression-free survival, locoregional progression-free survival, or overall survival (adj. p > 0.05). Of the patients who did (n = 124) and did not (n = 72) receive elective celiac RT, two (1.6%) and two patients (2.8%), respectively, relapsed in the celiac nodes. No patients failed in the splenic or porta nodes.
  
  
  CONCLUSIONS
  Most GEJ cancers can be safely treated without elective inclusion of splenic/porta nodes.
authors.affiliation: *Department of Radiation Oncology, and †Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030.
authors.forename: Jingya
authors.initials: J
authors.lastname: Wang
authors.forename: Denái R
authors.initials: DR
authors.lastname: Milton
authors.forename: Liru
authors.initials: L
authors.lastname: He
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: Peter F
authors.initials: PF
authors.lastname: Thall
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000401:mortality*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015996:Survival Rate; D055815:Young Adult