title: Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis.
abstract: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis.
  
  
  
  Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated.
  
  
  
  Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications.
  
  
  
  With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koëter
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Kathiravetpillai
authors.affiliation: Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Gooszen
authors.affiliation: Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: S S
authors.initials: SS
authors.lastname: Gisbertz
authors.affiliation: Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: M J C
authors.initials: MJ
authors.lastname: van der Sangen
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: M D P
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. Electronic address: grard.nieuwenhuijzen@catharinaziekenhuis.nl.
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: M C C M
authors.initials: MC
authors.lastname: Hulshof
mesh_terms: D000714:Anastomosis, Surgical / Q000401:mortality*; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000628:therapy*; D004940:Esophageal Stenosis / Q000401:mortality*; D016629:Esophagectomy / Q000401:mortality*; D004944:Esophagoplasty / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D020360:Neoadjuvant Therapy; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome