title: Effect of Neoadjuvant Radiation Dose on Surgical and Oncological Outcome in Locally Advanced Esophageal Cancer.
abstract: BACKGROUND
  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 (group1) versus a dose of > 40 Gy (group 1).
  
  
  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 (R0) 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 1), 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 (18% vs 3%, P < 0.001). Metastatic recurrence occurred in 48% in group 1 and 13% in group 1 (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.
authors.affiliation: a Departments of Gastrointestinal Surgery , Ghent , Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Van Daele
authors.affiliation: a Departments of Gastrointestinal Surgery , Ghent , Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Ceelen
authors.affiliation: b Radiation Oncology and Ghent , Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Boterberg
authors.affiliation: a Departments of Gastrointestinal Surgery , Ghent , Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Varinl
authors.affiliation: a Departments of Gastrointestinal Surgery , Ghent , Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Van Nieuwenhove
authors.affiliation: a Departments of Gastrointestinal Surgery , Ghent , Belgium.
authors.forename: D Van de
authors.initials: DV
authors.lastname: Putte
authors.affiliation: c Gastroenterology, Ghent University Hospital 9000 Ghent , Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Geboes
authors.affiliation: a Departments of Gastrointestinal Surgery , Ghent , Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Pattyn
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D016208:Databases, Factual; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis