title: Tolerance and dose-volume relationship of intrathoracic stomach irradiation after esophagectomy for patients with thoracic esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To identify the tolerance of radiation with a high prescribed dose and predictors for the development of intrathoracic stomach toxicity in patients with thoracic esophageal squamous cell carcinoma (SCC) after esophagectomy followed by gastric conduit reconstruction.
  
  
  METHODS
  From 2011 to 2013, 105 patients after esophagectomy were treated with postoperative radiotherapy. The intrathoracic stomach was outlined with the calculation of a dose-volume histogram (DVH) for the initial intended treatment of 6020 cGy or 6300 cGy. The volume of the intrathoracic stomach receiving each dose was recorded at 10-Gy intervals between 10 and 40 Gy and at 5-Gy intervals between 40 and 60 Gy. The grade of toxicities was defined by the National Cancer Institute Common Toxicity Criteria version 4.0.
  
  
  RESULTS
  The mean and maximum doses of the intrathoracic stomach were 2449 ± 986 cGy and 6519 ± 406 cGy, respectively. Sixteen (15.2%) and three (2.9%) experienced Common Toxicity Criteria Grade 2 and Grade 3 acute gastric toxicity. There were no Grade 4 toxicities. Fourteen patients (13.3%) exhibited late gastric complications possibly related to radiation. The volume percent of the intrathoracic stomach receiving at least 50 Gy (V50) was strongly associated with the degree of toxicity (p = 0.024, respectively). Multivariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicities.
  
  
  CONCLUSIONS
  The intrathoracic stomach is well tolerated with a high-dose irradiation for patients with esophageal SCC receiving radiotherapy after esophagectomy. A strong dose-volume relationship exists for the development of Grade 2 acute intrathoracic stomach toxicity in our study.
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Qi
authors: Q
authors: Liu
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Radiation Oncology, Shanghai Jiaotong University Chest Hospital, Shanghai, China.
authors: Xu-Wei
authors: XW
authors: Cai
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Radiation Oncology, Shanghai Jiaotong University Chest Hospital, Shanghai, China.
authors: Xiao-Long
authors: XL
authors: Fu
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Jun-Chao
authors: JC
authors: Chen
authors: Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
authors: Jia-Qing
authors: JQ
authors: Xiang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002681:China; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D011881:Radiotherapy, Computer-Assisted / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013270:Stomach / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clinical Section; esophageal carcinoma; intrathoracic stomach; radiotherapy; toxicity