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Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

The effect of dose escalation on gastric toxicity when treating lower oesophageal tumours: a radiobiological investigation

Authors: Rhys Carrington, John Staffurth, Samantha Warren, Mike Partridge, Chris Hurt, Emiliano Spezi, Sarah Gwynne, Maria A. Hawkins, Thomas Crosby

Published in: Radiation Oncology | Issue 1/2015

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Abstract

Purpose

Using radiobiological modelling to estimate normal tissue toxicity, this study investigates the effects of dose escalation for concurrent chemoradiation therapy (CRT) in lower third oesophageal tumours on the stomach.

Methods and materials

10 patients with lower third oesophageal cancer were selected from the SCOPE 1 database (ISCRT47718479) with a mean planning target volume (PTV) of 348 cm3. The original 3D conformal plans (50Gy3D) were compared to newly created RapidArc plans of 50GyRA and 60GyRA, the latter using a simultaneous integrated boost (SIB) technique using a boost volume, PTV2. Dose-volume metrics and estimates of normal tissue complication probability (NTCP) were compared.

Results

There was a significant increase in NTCP of the stomach wall when moving from the 50GyRA to the 60GyRA plans (11–17 %, Wilcoxon signed rank test, p = 0.01). There was a strong correlation between the NTCP values of the stomach wall and the volume of the stomach wall/PTV 1 and stomach wall/PTV2 overlap structures (R = 0.80 and R = 0.82 respectively) for the 60GyRA plans.

Conclusion

Radiobiological modelling suggests that increasing the prescribed dose to 60Gy may be associated with a significantly increased risk of toxicity to the stomach. It is recommended that stomach toxicity be closely monitored when treating patients with lower third oesophageal tumours with 60Gy.
Literature
1.
Botterweck AA, Schouten LJ, Volovics A, Dorant E, Van Den Brandt PA. Trends in incidence of adenocarcinoma of the oesophagys and gastric cardia in ten European countries. Int J Epidemiol. 2000;29(4):645–54.CrossRefPubMed
2.
Teoh AYB, Chiu PWY, Yeung WK, Liu SYW, Wong SKH, Ng EKW. Long-term survival outcomes after definitive chemoradiation versus surgery in patients with resectable squamous carcinoma of the esophagus: results from a randomized controlled trial. Ann Oncol. 2013;24(1):165–71.CrossRefPubMed
3.
Buergy D, Lorh F, Baack T, Siebenlist K, Haneder S, Michaely H, et al. Radiotherapy for tumours of the stomach and gastroesophageal junction - a review of its role in multimodal therapy. Radiat Oncol. 2012;7:192.PubMedCentralCrossRefPubMed
4.
Cunningham D, Starling N, Rao S. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358:36–46.CrossRefPubMed
5.
Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, et al. Combined Chemotherapy and Radiotherapy Compared with Radiotherapy Alone in Patients with Cancer of the Esophagus. N Engl J Med. 1992;326(24):1593–8.CrossRefPubMed
6.
Settle SH, Bucci MK, Palmer MB, Liu H, Liengsawangwong R, Guerrero TM, et al. PET/CT fusion with treatment planning CT (TP CT) shows predominant pattern of locoregional failure in esophagea patients treated with chemoradiation in in GTV. Int J Radiat Oncol Biol Phys. 2008;72:S72–S3.CrossRef
7.
Fakhrian K, Oechsner M, Kampfer S, Schuster T, Molls M, Geinitz H. Advanced techniques in neoadjuvant radiotherapy allow dose escalation without increased dose to organs at risk. Strahlenther Onkol. 2013;189:293–300.CrossRefPubMed
8.
Zhang Z, Liao Z, Jin J, Ajani J, Chang JY, Jeter M, et al. Dose–response relationship in locoregional control for patients with stage II-III esophageal cancer treated with concurrent chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys. 2005;61(3):656–64.CrossRefPubMed
9.
Geh JI, Bond SJ, Bentzen SM, Jones RG. Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: Evidence of a radiation and chemotherapy dose response. Radiother Oncol. 2006;78:236–44.CrossRefPubMed
10.
Bedford JL, Viviers L, Guzel Z, Childs PJ, Webb S, Tait DM. A quantitive treatment planning study evaluating the potential of dose escalation in conformal radiotherapy of the oesophagus. Radiother Oncol. 2000;57:183–93.CrossRefPubMed
11.
Hurt G, Nixon L, Griffiths G, Al-Mokhtar R, Gollins S, Staffurth J, et al. SCOPE1: a randomised phase II/III multicentre clinical trial of definitive chemoradiation, with or without cetuximab, in carcinoma of the oesphagus. BMC Cancer. 2011;11:466–78.PubMedCentralCrossRefPubMed
12.
Warren S, Partridge M, Carrington R, Hurt C, Crosby T, Hawkins M. Radiobiological determination of dose escalation and normal tissue toxicity in definitive chemoradiation therapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2014;90:423–9.PubMedCentralCrossRefPubMed
13.
Rubin P, Casarett GW. Clin Radiat Pathol. Vol 1. 1968. W.B. Saunders Co, 1st Edition.
14.
Gwynne S, Falk S, Gollins S, Wills L, Bateman A, Cummins S, et al. Oesophageal Chemoradiotherapy in the UK - A Current Practive and Future Directions. Clin Oncol. 2013;25:368–77.CrossRef
15.
Hawkins MA, Aitken A, Hansen VN, McNair HA, Tait DM. Set-up errors in radiotherapy for oesophageal cancers – Is electronic portal imaging or conebeam more accurate? Radiother Oncol. 2011;98(2):249–54.CrossRefPubMed
16.
Rapaccini GL, Aliotta A, Pompili M, Grattagliano A, Anti M, Merlino B, et al. Gastric wall thickness in normal and neoplastic subjects: a prospective study performed by abdominal ultrasound. Gastrointest Radiol. 1988;13(3):197–9.CrossRefPubMed
17.
Pickhardt PJ, Asher DB. Wall thickening of the gastric antrum as a normal finding: multidetector CT with cadaveric comparison. AJR Am J Roentgenol. 2003;181(4):973–9.CrossRefPubMed
18.
Kavanagh BD, Pan CC, Dawson LA, Das SK, Allen X, Haken RKT, et al. Radiation Dose-Volume Effectes in the Stomach and Small Bowel. Int J Radiat Oncol Biol Phys. 2010;76(3):S101–S7.CrossRefPubMed
19.
Gwynne S, Spezi E, Wills L, Nixon L, Hurt C, Joseph G, et al. Toward semi-automated assessment of target volume delineation in radiotherpay trials: the SCOPE 1 pretrial test case. Int J Radiat Oncol Biol Phys. 2012;84(4):1037–42.CrossRefPubMed
20.
Gagliardi G, Lax I, Ottolenghi A, Rutqvist LE. Long-term cardiac mortality after radiotherapy of breast cancer - application of the relative seriality model. Br J Radiol. 1996;69(825):839–46.CrossRefPubMed
21.
De Jaeger K, Hoogeman MS, Engelsman M, Seppenwoolde Y, Damen EMF, Mijnher BJ, et al. Incorporatin an improved dose-calculation algorithm in conformal radiotherapy of lung cancer: re-evaluation of dose in normal lung tissue. Radiother Oncol. 2003;69(1):1–10.CrossRefPubMed
22.
Burman C, Kutcher GJ, Emami B, Goitein M. Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys. 1991;21(1):123–5.CrossRefPubMed
23.
Feng M, Normolle D, Pan CC, Dawson LA, Amarnath S, Ensminger WD, et al. Dosimetric Analysis of Radiation-Induced Gastric Bleeding. Int J Radiat Oncol Biol Phys. 2012;84(1):e1.PubMedCentralCrossRefPubMed
24.
Roeder F, Nicolay NH, Nguyen T, Ebrahimi LS, Askoxylakis V, Bostel T, et al. Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer. Radiat Oncol. 2014;9:191.PubMedCentralCrossRefPubMed
25.
Lever FM, Lips IM, Crijns SPM, Reerink O, van Lier ALHMW, Moerland MA, et al. Quantification of Esophageal Tumor Motion on Cine-Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys. 2014;88(2):419–24.CrossRefPubMed
26.
Wang J, Lin SH, Dong L, Balter P, Mohan R, Komaki R, et al. Quantifying the Interfractional Displacement of the Gastroesophageal Junction during Radiation Therapy for Esophageal Cancer. Int J Radiat Oncol Biol Phys. 2012;83(2):e273–e80.PubMedCentralCrossRefPubMed
27.
Nakamura A, Shibuya K, Nakamura M, Matsuo Y, Shiinoki T, Nakata M, et al. Interfractional dose variations in the stomach and the bowels during breathhold intensity-modulated radiotherapy for pancreatic cancer: Implications for a dose-escalation strategy. Med Phys. 2013;40(2):021701.
28.
Kumagai M, Hara R, Mori S, Yanagi T, Asakura H, Kishimoto R, et al. Impact of Intrafractional Bowel Gas Movement on Carbon Ion Beam Dose Distribution in Pancreatic Radiotherapy. Int J Radiat Oncol Biol Phys. 2009;73(4):1276–81.CrossRefPubMed
29.
Bouchard M, McAleer MF, Starkchall G. Impact of gastric filling on radiation dose delivered to gastroesophageal junction tumours. Int J Radiat Oncol Biol Phys. 2010;77:292–300.CrossRefPubMed
Metadata
Title
The effect of dose escalation on gastric toxicity when treating lower oesophageal tumours: a radiobiological investigation
Authors
Rhys Carrington
John Staffurth
Samantha Warren
Mike Partridge
Chris Hurt
Emiliano Spezi
Sarah Gwynne
Maria A. Hawkins
Thomas Crosby
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0537-y

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