Adaptative radiation therapy after surgery for gastric-esophageal carcinoma

HISTORY Patient 54 years old with ulcerated gastric carcinoma (mucinous adenocarcinoma G2 pT3 pN0 pMx 3.5 cm.full wall infiltrating) treated with total gastrectomy and chemotherapy (3 cycle CDDP+5FU+EPI).
RADIATION THERAPY DISTRIBUTION DOSE
It was planned treatment with adaptative radiation therapy (RT with LINAC 15MV).
The planning was organized with three fields: front, right rear oblique field and left rear oblique field.
It was planned and carried out with a daily dose of 1.8Gy and final dose of 45 Gy.


A coronal: location of intra-thoracic esophageal-jejunal anastomosis (red arrows)
B coronal: volume planning of the area to be treat (pink color)
C coronal: area to be treat with their isodose curves
D sagittal: location of intra-thoracic esophageal-jejunal anastomosis (red arrows)
E sagittal: volume planning of the area to be treat (pink color)
F sagittal: area to be treat with their isodose curves
G axial: start bordering of the area to be treat (red line) and the area to be exclude (light blue line)
H: graphic depiction of the isodose curves. Best chance of rapid dose attenuation in critical organs. Sufficiently constant dose on the target to be treat
I axial: end bordering of the entire area to be treat (red line) and the entire area to be exclude (light blue line)

CHECKING THE RESULTS
At the end of treatment we used the same “adaptative mode” for the follow up of the patient. The patient has no signs of locoregional or distant recurrence after one and eighteen months from radiation therapy and also after three and a half years from gastrectomy.