Objective: Gastroesophageal junction carcinoma (GJC) is a frequent type of upper gastrointestinal tract cancer with rising incidence. Local recurrence may be frequent during the course of disease. Management
of patients must be performed on an individual basis by use of multidisciplinary strategy. Surgery serves
as the main modality of management for GJC, nevertheless, radiation therapy (RT) may also be used
for treatment. RT may play an integral role as the supplementary or definitive therapeutic option, and
recurrent disease may also benefit from irradiation. Treatment of recurrent MCC may be more challenging,
however, RT has been used for recurrent GJC management to achieve optimal therapeutic outcomes. In this
original research article, we sought to evaluate treatment volume determination for recurrent GJC.
Materials and Methods: The main purpose of this study was to evaluate treatment volume determination
for recurrent GJC irradiation based on CT only or fused CT-MRI. We have conducted a comparative analysis
for assessment of treatment volume determination by CT simulation images only or by integration of MRI.
Results: Ground truth target volume served as the reference for comparative assessment, and results
revealed that use of fused CT-MRI based treatment volume determination has been identical with ground
truth treatment volume determination in this selected group of patients with recurrent GJC.
Conclusion: Multimodality imaging with incorporation of MRI in RT treatment volume determination
process may be utilized for patients with recurrent GJC. Clearly, further studies are required to shed light
on this critical issue.
Gastroesophageal junction carcinoma (GJC) is a frequent type
of upper gastrointestinal tract cancer with rising incidence [1-
7]. Local recurrence may be frequent during the course of disease.
Management of patients must be performed on an individual basis
by use of multidisciplinary strategy. Surgery serves as the main
modality of management for GJC, nevertheless, radiation therapy
(RT) may also be used for treatment. RT may play an integral role as
the supplementary or definitive therapeutic option, and recurrent
disease may also benefit from irradiation. Treatment of recurrent MCC
may be more challenging, however, RT has been used for recurrent
GJC management to achieve optimal therapeutic outcomes. Improved
treatment results may be achieved in cancer management in the
millenium era with several advances in technology. Within this context, quality of life issues and normal tissue sparing may be considered as pertinent aspects of contemporary irradiation. Incorporation
of sophisticated therapeutic approaches and technologies such as
molecular imaging methods, automatic segmentation techniques,
Image Guided RT (IGRT), Intensity Modulated RT (IMRT), stereotactic
RT, and adaptive RT (ART) may improve RT results [8-49].
Nevertheless, improvements in target definition may be considered as
an important part of contemporary irradiation approaches. Currently,
common practice includes utilization of Computed Tomography
(CT) simulation for acquisition of radiation treatment planning
images, nevertheless, integration of other imaging modalities such
as Magnetic Resonance Imaging (MRI) may substantially add to the
accuracy of target definition as addressed in other studies [50-93]. In
this original research article, we sought to evaluate treatment volume
determination for recurrent GJC.
Department of Radiation Oncology at Gulhane Medical
Faculty, University of Health Sciences serves as a tertiary cancer
center with the capability of treating a huge patient population from
several places from Turkey and other countries. Within this context,
we have been irradiating a plethora of cancers annually for decades.
The main purpose of this study was to evaluate treatment volume
determination for recurrent GJC irradiation based on CT only or fused
CT-MRI. We have conducted a comparative analysis for assessment
of treatment volume determination by CT simulation images only
or by integration of MRI. Primary objective of this original research
article was to evaluate the inclusion of multimodality imaging for
treatment volume determination, however, contouring of critical
structures, interobserver and intraobserver variations were
also assessed. Ground truth target volume has been utilized for
comparative analysis, and was defined by board certified radiation
oncologists after detailed evaluation of all imaging and related data
with thorough colleague peer review and consensus. Decision making
procedure for optimal treatment has involved multidisciplinary
input from experts on surgical oncology, radiation oncology, medical
oncology. Individualized patient evaluation included consideration of
patient, disease, and treatment related factors. Patient age, previous
treatments, symptomatology, lesion size, performance status, lesion
location and association with critical structures, contemplated
outcomes of therapies, patient preferences and logistical issues have
been all considered. The Linear Accelerator (LINAC) furnished with
the capability of contemporary IGRT techniques has been utilized for
RT. Following rigid patient immobilization, planning CT images were
acquired at CT simulator for radiation treatment planning. Then,
acquired RT planning images have been transferred to the delineation
workstation through the network. Target volumes and normal tissues
have been defined on these images and structure sets have been
generated. Either CT simulation images only or fused CT-MR images
have been used for assessment and comparative analysis.
This original research article was designed to assess the utility
of multimodality imaging with integration of MRI for treatment
volume determination in a selected group of patients with recurrent
GJC. Treatment of patients was executed at our Radiation Oncology
Department of Gulhane Medical Faculty at University of Health
Sciences, Ankara. Before irradiation, patients have been assessed
individually by a multidisciplinary team of experts from surgical
oncology, medical oncology and radiation oncology. Briefly, we carried
out a comparative analysis based on either CT only imaging or by fused
CT-MRI to assess the utility of this contemporary approach. Optimal
radiation treatment planning procedure included consideration of
lesion sizes, localization and association with surrounding normal
tissues. Radiation physicists were involved in radiation treatment
planning processs with consideration of reports by American
Association of Physicists in Medicine (AAPM) and International
Commission on Radiation Units and Measurements (ICRU). Precise
radiation treatment planning procedure included consideration of
electron density, tissue heterogeneity, CT number and HU values in CT
images. Primary objective of radiation treatment planning has been to
achieve optimal coverage of treatment volume with minimal exposure
of surrounding critical structures. Ground truth target volume served
as the reference for comparative assessment, and results revealed
that use of fused CT-MRI based treatment volume determination has
been identical with ground truth treatment volume determination in
this selected group of patients with recurrent GJC.
GJC can be considered as a frequently encountered type of upper
gastrointestinal tract cancers with rising incidence. Recurrent disease
may be observed despite initial management. Treatment of patients
should be done on an individual basis by use of a multidisciplinary
approach. Surgery is the main therapeutic modality for management
of GJC, however, RT may also be used for management. RT can have
an important role as the supplementary or definitive therapeutic
option, and recurrent disease may also be treated by RT. Management
of recurrent GJC may be more challenging, nevertheless, RT can be
utilized for recurrent GJC management to achieve optimal therapeutic
outcomes. Better therapeutic results may be achieved in cancer
management in the millenium era by virtue of several advances in
technology. Within this context, quality of life issues and critical organ
protection may be considered as critical aspects of sophisticated
RT strategies. Integration of contemporary treatment strategies
and technologies such as molecular imaging methods, automatic
segmentation techniques, IGRT, IMRT, stereotactic RT, and ART may
further improve therapeutic outcomes [8-49]. However, precision in
target definition may be considered as an indispensable component
of sophisticated RT strategies. Meanwhile, widely accepted practice
includes use of CT simulation for acquisition of radiation treatment planning images, however, incorporation of other imaging modalities such as MRI may add to the precision of target definition as addressed
in other studies [50-93]. In this original research article, we aimed
to assess treatment volume determination for recurrent GJC. In
conclusion, multimodality imaging with incorporation of MRI in RT
treatment volume determination process may be utilized for patients
with recurrent GJC. Clearly, further studies are required to shed light
on this critical issue.
Sager O, Beyzadeoglu M, Dincoglan F, Demiral S, Gamsiz H, et al. (2020) Multimodality management of cavernous sinus meningiomas with less extensive surgery followed by subsequent irradiation: Implications for an improved toxicity profile. J Surg Surgical Res 6: 056-061.
Beyzadeoglu M, Sager O, Dincoglan F, Demiral S, Uysal B, et al. (2020) Single Fraction Stereotactic Radiosurgery (SRS) versus Fractionated Stereotactic Radiotherapy (FSRT) for Vestibular Schwannoma (VS). J Surg Surgical Res 6: 062-066.
Dincoglan F, Beyzadeoglu M, Sager O, Demiral S, Uysal B, et al. (2020) A Concise Review of Irradiation for Temporal Bone Chemodectomas (TBC). Arch Otolaryngol Rhinol 6: 016-020.
Demiral S, Beyzadeoglu M, Sager O, Dincoglan F, Gamsiz H, et al. (2014) Evaluation of Linear Accelerator (Linac)-Based Stereotactic Radiosurgery (Srs) for the Treatment of Craniopharyngiomas. UHOD-Uluslararasi Hematoloji Onkoloji Dergisi 24(2): 123-129.
Demiral S, Beyzadeoglu M, Sager O, Dincoglan F, Gamsiz H, et al. (2014) Evaluation of linear accelerator (linac)-based stereotactic radiosurgery (srs) for the treatment of craniopharyngiomas. UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi 24: 123-129.
Beyzadeoglu M, Dincoglan F, Demiral S, Sager O (2023) An Original Article Revisiting the Utility of Multimodality Imagıng For Refıned Target Volume Determinatıon Of Recurrent Kidney Carcinoma. Canc Therapy & Oncol Int J 23(5): 556122.
Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2022) Assessment of Target Definition for Extramedullary Soft Tissue Plasmacytoma: Use of Multımodalıty Imaging for Improved Targetıng Accuracy. Canc Therapy & Oncol Int J 22(4): 556095.
Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Reappraisal of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Target Definition for Radiotherapeutic Management of Recurrent Anal Squamous Cell Carcinoma (ASCC): An Original Article. Canc Therapy & Oncol Int J 22(2): 556085.
Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2022) An Original Article for Assessment of Multimodality Imaging Based Precise Radiation Therapy (Rt) in the Management of Recurrent Pancreatic Cancers. Canc Therapy & Oncol Int J 22(1): 556078.
Demiral S, Beyzadeoglu M, Dincoglan F, Sager O (2020) Assessment of Target Volume Definition for Radiosurgery of Atypical Meningiomas with Multimodality Imaging. Journal of Hematology and Oncology Research 3: 14-21.
ISSN: 2574 -1241
Abstract
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