Positive margin at esophagojejunostomy

[seper]

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Hello all,

I'm seeing a case of stomach Ca, s/p total gastrectomy and primary esophagojejunostomy. Proximal margin is microscopically positive. I'm inclined to boost positive margin to about 55 Gy, despite that being small bowel. Would anyone be comfortable with this, or go even higher?

 

[Palex80]

I'd stop at 50.4 probably...

 

[deleted4401]

I'd go 55ish, try to keep QUANTEC goals and let them know that there is a risk of obstruction requiring surgical correction. But, no right answer to this...

 

[Gfunk6]

Extremely tough call. The MacDonald Trial (INT-0116) required an R0 surgical resection prior to adjuvant chemoXRT so that doesn't exactly apply to this case.

Personally, I would use small bowel dosing guidelines in RTOG 0848 (post-op pancreas). Ideal small bowel max dose is 54 Gy and absolute maximum is 56 Gy. With that in mind, 55 Gy is probably feasible to the area of microscopic margin.