title: Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation and transhiatal esophagectomy.
abstract: BACKGROUND
  Neoadjuvant chemoradiation might increase anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. The aim of this study was to determine the influence of radiation dose on the incidence of leakage and stenosis.
  
  
  METHODS
  Fifty-three patients with esophageal cancer received neoadjuvant chemoradiation (23 × 1.8 Gy) (combined with Paclitaxel and Carboplatin) followed by a transhiatal esophagectomy between 2009 and 2011. On planning CT, the future anastomotic region was determined and the mean radiation dose, V20, V25, V30, V35 and V40 were calculated. Logistic regression analysis was conducted to examine determinants of anastomotic leakage and stenosis.
  
  
  RESULTS
  Anastomotic leaks occurred in 13 of 53 patients (25.5%) and anastomotic stenosis occurred in 24 of 53 patients (45.3%). Median follow-up was 20 months. Logistic regression analysis showed that mean dose, V20-V40, age, co-morbidity, method of anastomosis, operating time and interval between last radiotherapy treatment and surgery were not predictors of anastomotic leakage and stenosis.
  
  
  CONCLUSIONS
  A radiation dose of 23 × 1.8 Gy on the future anastomotic region has no influence on the occurrence of anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by transhiatal esophagectomy.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. marijnkoeter@gmail.com.
authors.forename: Marijn
authors.initials: M
authors.lastname: Koëter
authors.affiliation: Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. maurice.vd.sangen@catharinaziekenhuis.nl.
authors.forename: Maurice J C
authors.initials: MJ
authors.lastname: van der Sangen
authors.affiliation: Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. coen.hurkmans@catharinaziekenhuis.nl.
authors.forename: Coen W
authors.initials: CW
authors.lastname: Hurkmans
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. misha.luyer@catharinaziekenhuis.nl.
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. harm.rutten@catharinaziekenhuis.nl.
authors.forename: Harm J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. grard.nieuwenhuijzen@catharinaziekenhuis.nl.
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011183:Postoperative Complications; D011379:Prognosis; D011879:Radiotherapy Dosage / Q000592:standards*; D015996:Survival Rate
chemical_list: D016190:Carboplatin; D017239:Paclitaxel