Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Influence of Delayed Gastric Emptying in Radiotherapy after a Subtotal Gastrectomy

위부분절제술 후 방사선치료에서 음식물 배출지연에 따른 영향

  • Kim, Dong-Hyun (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Won-Taek (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Lee, Mi-Ran (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Ki, Yong-Gan (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Nam, Ji-Ho (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Park, Dal (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Jeon, Ho-Sang (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Jeon, Kye-Rok (Departments of Biomedical Engineering, Pusan National University School of Medicine) ;
  • Kim, Dong-Won (Departments of Radiation Oncology, Pusan National University School of Medicine)
  • 김동현 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김원택 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 이미란 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 기용간 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 남지호 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 박달 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 전호상 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 전계록 (부산대학교 의학전문대학원 의공학교실) ;
  • 김동원 (부산대학교 의학전문대학원 방사선종양학교실)
  • Received : 2009.09.03
  • Accepted : 2009.11.02
  • Published : 2009.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This aim of this study was to evaluate changes in gastric volume and organ position as a result of delayed gastric emptying after a subtotal gastrectomy performed as part of the treatment of stomach cancer. Materials and Methods: The medical records of 32 patients who underwent concurrent chemoradiotherapy after a subtotal gastrectomy from March 2005 to December 2008 were reviewed. Of these, 5 patients that had more than 50 cc of residual gastric food detected at computed tomography (CT) simulation, were retrospectively enrolled in this study. Gastric volume and organ location was measured from CT images obtained before radiotherapy, twice weekly. In addition, authors evaluated the change of radiation dose distribution to planning the target volume and normal organ in a constant radiation therapy plan regardless of gastric volume variation. Results: A variation in the gastric volume was observed during the radiotherapy period (64.2~340.8 cc; mean, 188.2 cc). According to the change in gastric volume, the location of the left kidney was shifted up to 0.7 - 2.2 cm (mean, 1.2 cm) in the z-axis. Under-dose to planning target volume (V43, 79.5${\pm}$10.4%) and over-dose to left kidney (V20, 34.1${\pm}$12.1%; Mean dose, 23.5${\pm}$8.3 Gy) was expected, given that gastric volume change due to delayed gastric emptying wasn't taken into account. Conclusion: This study has shown that a great change in gastric volume and left kidney location may occur during the radiation therapy period following a subtotal gastrectomy, as a result of delayed gastric emptying. Detection of patients who experienced delayed gastric emptying and the application of gastric volume variation to radiation therapy planning will be very important.

목 적: 위부분절제술 후 방사선치료를 받는 환자들 중에서 위 내 음식물의 배출지연으로 인한 위 용적 및 주변 장기의 위치 변화와 이것의 임상적 의의를 알아보고자 하였다. 대상 및 방법: 2005년 3월 1일부터 2008년 12월 31일까지 위암으로 위부분절제술을 받은 후 보조적 동시항암화학 방사선치료를 받았던 총 32명의 환자들 중, 전산화단층촬영모의치료 영상에서 12시간 이상의 금식에도 불구하고 위 내 음식물이 50 ml 이상 남아 잔존 위의 팽대를 보였던 경우들이 이번 연구 대상이었다. 이 환자들에 대해 방사선치료 기간 동안 주기적으로 시행된 컴퓨터단층촬영 자료를 바탕으로 잔존 위 용적 및 주변 장기들의 위치 변화를 평가하였다. 또한 방사선치료 설계 자료를 바탕으로, 잔존 위 및 주변 장기들의 변화를 고려하지 않고 치료를 지속했을 경우의 치료 표적 및 정상조직의 방사선분포 변화를 알아보았다. 결 과: 총 5명의 전산화단층촬영모의치료 영상에서 배출장애에 의한 50 ml 이상의 위 내 음식물의 저류가 확인되었다. 대상 환자들에서 위 용적은 치료과정 중에 다양한 변화양상을 보였고, 각 환자에서 최대 64.2~340.8 ml (평균, 188.2 ml)의 변화를 보였다. 또한 위 용적에 따라 좌측 신장이 각 환자별 최대 0.7~2.2 cm (평균, 1.2 cm)까지 상하 방향으로 이동하는 양상을 보였다. 모의치료 시의 설계를 위 용적의 변화에 따라 변경하지 않고 치료를 진행한 경우 유의하게 계획용표적체적(V43, 79.5${\pm}$10.4%)에 조사선량이 부족하고 좌측 신장(V20, 34.1${\pm}$12.1%; Mean dose, 23.5${\pm}$8.3 Gy)에 과도한 선량이 조사되는 결과를 얻을 수 있었다. 결 론: 위부분절제술 후 방사선치료를 받는 일부 환자에서 배출지연에 따른 위 용적의 변화와 좌측 신장의 위치변화를 확인할 수 있었다. 배출지연이 발생하는 환자를 선별하여 위 용적의 변화를 파악하고 이를 방사선치료 설계에 반영하는 것이 효과적일 것으로 생각된다.

Keywords

References

  1. Hazard L, O'Connor J, Scaife C. Role of radiation therapy in gastric adenocarcinoma. World J Gastroenterol 2006;12:1511-1520 https://doi.org/10.3748/wjg.v12.i10.1511
  2. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725-730 https://doi.org/10.1056/NEJMoa010187
  3. Soyfer V, Corn BW, Melamud A, et al. Threedimensional non-coplanar conformal radiotherapy yields better results than traditional beam arrangements for adjuvant treatment of gastric cancer. Int J Radiat Oncol Biol Phys 2007;69:364-369 https://doi.org/10.1016/j.ijrobp.2007.03.032
  4. Leong T, Willis D, Joon DL, Condron S, Hui A, Ngan SY. 3D conformal radiotherapy for gastric cancer: results of a comparative planning study. Radiother Oncol 2005;74:301-306 https://doi.org/10.1016/j.radonc.2005.01.006
  5. Gunderson LL, Hoskins RB, Cohen AC, Kaufman S, Wood WC, Carey RW. Combined modality treatment of gastric cancer. Int J Radiat Oncol Biol Phys 1983;9:965-975 https://doi.org/10.1016/0360-3016(83)90383-8
  6. Jung HJ, Lee JH, Ryu KW, et al. The influence of reconstruction methods on food retention phenomenon in the remnant stomach after a subtotal gastrectomy. J Surg Oncol 2008;98:11-14 https://doi.org/10.1002/jso.21076
  7. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 2nd English edition. Gastric Cancer 1998;1:10-24
  8. Gunderson LL, Sosin H. Adenocarcinoma of the stomach:areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 1982;8:1-11
  9. Landry J, Tepper JE, Wood WC, Moulton EO, Koerner F, Sullinger J. Patterns of failure following curative resection of gastric carcinoma. Int J Radiat Oncol Biol Phys 1990;19:1357-1362 https://doi.org/10.1016/0360-3016(90)90344-J
  10. Bottke D, Wiegel T. Adjuvant radiotherapy after radical prostatectomy: indications, results and side effects. Urol Int 2007;78:193-197 https://doi.org/10.1159/000099336
  11. Bussels B, Goethals L, Feron M, et al. Respirationinduced movement of the upper abdominal organs: a pitfall for the three-dimensional conformal radiation treatment of pancreatic cancer. Radiother Oncol 2003;68:69-74 https://doi.org/10.1016/S0167-8140(03)00133-6
  12. van Sornsen de Koste JR, Senan S, Kleynen CE, Slotman BJ, Lagerwaard FJ. Renal mobility during uncoached quiet respiration: an analysis of 4DCT scans. Int J Radiat Oncol Biol Phys 2006;64:799-803 https://doi.org/10.1016/j.ijrobp.2005.09.012
  13. Horst E, Micko O, Moustakis C, Schunk A, Schafer U, Willich NA. Conformal therapy for pancreatic cancer:variation of organ position due to gastrointestinal distention:implications for treatment planning. Radiology 2002;222:681-686 https://doi.org/10.1148/radiol.2223010639
  14. Wieland P, Dobler B, Mai S, et al. IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a stepand-shoot and an arc therapy approach. Int J Radiat Oncol Biol Phys 2004;59:1236-1244 https://doi.org/10.1016/j.ijrobp.2004.02.051
  15. Ringash J, Perkins G, Brierley J, et al. IMRT for adjuvant radiation in gastric cancer: a preferred plan? Int J Radiat Oncol Biol Phys 2005;63:732-738 https://doi.org/10.1016/j.ijrobp.2005.03.013
  16. Kassam Z, Lockwood G, O'brien C, et al. Conformal radiotherapy in the adjuvant treatment of gastric cancer: review of 82 cases. Int J Radiat Oncol Biol Phys 2006;65:713-719 https://doi.org/10.1016/j.ijrobp.2006.01.001
  17. Watanabe H, Adachi W, Koide N, Yazawa I. Food residue at endoscopy in patients who have previously undergone distal gastrectomy: risk factors and patient preparation. Endoscopy 2003;35:397-401 https://doi.org/10.1055/s-2003-38776
  18. Pedrazzani C, Marrelli D, Rampone B, et al. Postoperative complications and functional results after subtotal gastrectomy with Billroth II reconstruction for primary gastric cancer. Dig Dis Sci 2007;52:1757-1763 https://doi.org/10.1007/s10620-006-9655-6
  19. Della Biancia C, Hunt M, Furhang E, Wu E, Yahalom J. Radiation treatment planning techniques for lymphoma of the stomach. Int J Radiat Oncol Biol Phys 2005;62:745-751 https://doi.org/10.1016/j.ijrobp.2004.10.025
  20. Bak J, Park SH, Park SW. A study on the availability of the On-Board Imager (OBI) and Cone-Beam CT (CBCT) in the verification of patient set-up. J Korean Soc Ther Radiol Oncol 2008;26:118-125 https://doi.org/10.3857/JKSTRO.2008.26.2.118
  21. Ding GX, Coffey CW. Radiation dose from kilovoltage cone beam computed tomography in an image-guided radiotherapy procedure. Int J Radiat Oncol Biol Phys 2009;73:610-617 https://doi.org/10.1016/j.ijrobp.2008.10.006