Preoperative Chemoradiotherapy for Gastroesophageal Junction Adenocarcinoma Modified by PET/CT: Results of Virtual Planning Study

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Authors	SLÁVIK Marek BURKOŇ Petr SELINGEROVÁ Iveta KRUPA Pavel KAZDA Tomáš STANKOVA Jaroslava NIKL Tomas HEJNOVÁ Renata ŘEHÁK Zdeněk OŠMERA Pavel PROCHÁZKA Tomáš DVORAKOVA Eva POSPÍŠIL Petr GRELL Peter ŠLAMPA Pavel OBERMANNOVÁ Radka
Year of publication	2021
Type	Article in Periodical
Magazine / Source	Medicina-Lithuania
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.mdpi.com/1648-9144/57/12/1334
Doi	http://dx.doi.org/10.3390/medicina57121334
Keywords	gastroesophageal junction cancer; PET; CT; radiotherapy; neoadjuvant chemoradiotherapy
Description	Background and Objectives: The treatment of gastroesophageal junction (GEJ) adenocarcinoma consists of either perioperative chemotherapy or preoperative chemoradiotherapy. Radiotherapy (RT) in the neoadjuvant setting is associated with a higher probability of resections with negative margins (R0) and better tumor regression rate, which might be enhanced by incrementing RT dose with potential impact on treatment results. This virtual planning study demonstrates the feasibility of increasing the dose to GEJ tumor and involved nodes using PET/CT imaging. Materials and Methods: 16 patients from the chemoradiotherapy arm of the phase II GastroPET study were treated by a prescribed dose of 45.0 Gray (Gy) in 25 fractions. PET/CT was performed before treatment. The prescribed dose was virtually boosted on PET/CT-positive areas to 54.0 Gy by 9 Gy in 5 fractions. Dose-volume histograms (DVH) were compared, and normal tissue complication (NTCP) modeling was performed for both dose schedules. Results: DVHs were exceeded in mean heart dose in one case for 45.0 Gy and two cases for 54.0 Gy, peritoneal space volume criterion V-45Gy < 195 ccm in three cases for 54.0 Gy and V-15Gy < 825 ccm in one case for both dose schedules. The left lung volume of 25 Gy isodose exceeded 10% in most cases for both schedules. The NTCP values for the heart, spine, liver, kidneys and intestines were zero for both schemes. An increase in NTCP value was for lungs (median 3.15% vs. 4.05% for 25 x 1.8 Gy and 25 + 5 x 1.8 Gy, respectively, p = 0.013) and peritoneal space (median values for 25 x 1.8 Gy and 25 + 5 x 1.8 Gy were 3.3% and 14.25%, respectively, p < 0.001). Conclusion: Boosting PET/CT-positive areas in RT of GEJ tumors is feasible, but prospective trials are needed.
Related projects:	Sekvenční FDG-PET a miRNA jako biomarker změny strategie předoperační léčby u lokálně pokročilého karcinomu žaludku a gastroesofageální junkce Český národní uzel Evropské sítě infrastruktur klinického výzkumu (CZECRIN)