Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Table 1 Patient demographics and treatment

Variables		Median/n	Range/%
	Age	77.4	57.5-88.0
	Male	20	64.5
Site of cancer	Oesophageal	21	67.7
	GOJ (Siewert I/II)	1	3.2
	GOJ (Siewert III)	2	6.5
	Gastric	7	22.6
Type of cancer	Oesophageal SCC	16	51.6
	Oesophageal adenocarcinoma	6	19.4
	Gastric adenocarcinoma	9	29.0
Endoscopy data	Patients with both proximal and distal fiducial placed	24	77.4
	Patients with solely proximal or distal fiducials placed	7	22.6
ECOG	0	13	41.9
	1	11	35.5
	2	7	22.6
Stages1	LN negative without distant metastasis	21	67.7
	LN positive without distant metastasis	6	19.4
	Distant metastasis present	3	9.6
Radiotherapy	Fiducial seen on CBCT	29	93.5
	Fiducial-based IGRT	27	87.1
Treatment intent	Neoadjuvant chemotherapy with oesophagectomy	3	9.7
	Definitive chemoradiotherapy	12	38.7
	Palliative chemoradiotherapy	3	9.7
	Definitive radiotherapy	8	25.8
	Palliative radiotherapy	5	16.1

¹Staging as per AJCC 8^th edition. T-stage was not available for all patients as endoscopic ultrasound is not routinely performed at our center.

SCC: Squamous cell carcinoma; ECOG: Eastern Cooperative Oncology Group; GOJ: Gastro-oesophageal junction; LN: Lymph Node; CBCT: Cone-beam computerized tomography; IGRT: Image-guided radiotherapy.

Table 2 Patient demographics and treatment details based on fiducial-based image-guided radiotherapy and standard image-guided radiotherapy

Variables		F-IGRT	S-IGRT
		Median/n, range/%	Median/n, range/%
	Age	77.4, 57.5-88.0	77.3, 64.8-85.4
	Male	19, 70.4	1, 25.0
Site of cancer	Oesophageal	18, 62.1	3, 75.0
	GOJ (Siewert I/II)	0, 0.0	1, 25.0
	GOJ (Siewert III)	2, 7.4	0, 0.0
	Gastric	7, 25.9	0, 0.0
Type of cancer	Oesophageal SCC	13, 48.1	3, 75.0
	Oesophageal adenocarcinoma	5, 18.5	1, 25.0
	Gastric adenocarcinoma	9, 33.3	0, 0.0
Endoscopy data	Patients with both proximal and distal fiducial placed	22, 81.5	2, 50.0
	Patients with solely proximal or distal fiducials placed	5, 18.5	2, 50.0
ECOG	0	11, 40.7	2, 50.0
	1	9, 33.3	2, 50.0
	2	7, 25.9	0, 0.0
Stages1	LN negative without distant metastasis	18, 66.7	4, 100.0
	LN positive without distant metastasis	6, 22.2	0, 0.0
	Distant metastasis present	3, 11.1	0, 0.0
Treatment details	Time to treatment (d)	19.0, 9.0-44	14 .0, 9.0-17.0
	Curative intent	20, 74.1	4, 100.0
	Palliative intent	7, 25.9	0, 0.0
	Dose (Grays)	50, 25.2-55	47.7, 41.4-54
	Fraction	25, 10-30	26.5, 23-30
	Duration (d)	30, 14-47	37, 30-39
	Chemotherapy	14, 51.9	4, 100.0

¹Staging as per American Joint Committee on Cancer 8^th edition. T-stage was not available for all patients as endoscopic ultrasound is not routinely performed at our center.

F-IGRT: Fiducial-based image-guided radiotherapy; S-IGRT: Standard image-guided radiotherapy; SCC: Squamous cell carcinoma; ECOG: Eastern Cooperative Oncology Group; GOJ: Gastro-oesophageal junction; LN: Lymph Node.

Table 3 Subgroup analysis of overall survival, progression-free survival and 5-year survival

Subgroups		OS (mo)	PFS (mo)	5-yr survival (%)
		Median/n, range/%	Median/n, range/%
Treatment	F-IGRT (n = 27)	21.0, 0-87	12.0, 0-74	47.2
	S-IGRT (n = 4)	17.0, 3-49	18.0, 2-32	0.0
Intent	Curative (n = 23)	22.0, 0-87	14.0, 0-74	51.5
	Palliative (n = 8)	8.0, 0-79	4, 0-13	30.0
Location	Oesophageal (n = 22)	18, 0-87	13, 0-74	42.8
	SCC (n = 16)	20, 1-87	14, 1-74	62.0
	AC (n = 6)	10, 0-54	7, 0-19	0.0
	Gastric (n=9)	25, 0-79	13, 0-53	55.6

F-IGRT: Fiducial-based image-guided radiotherapy; S-IGRT: Standard image-guided radiotherapy; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; OS: Overall survival; PFS: Progression-free survival.

Table 4 Complications

	LF-IGRT only	LF-IGRT with chemotherapy	S-IGRT with chemotherapy	Overall
Hospitalization	3	4	2	9
Fatigue (G1/G2/G3)	1/2/0	3/1/0	2/0/0	6/3/0
Odynophagia G1/G2/G3	3/1/1	2/4/1	0/4/0	5/9/2
Dysphagia (G1/G2/G3)	2/0/0	0/1/0	0/1/1	2/2/1
Oesophageal stricture (G1/G2/G3)	1/0/0	0/0/1	0/0/1	1/0/2
Nausea (G1/G2/G3)	0/2/1	-	-	0/2/1
Diarrhoea (G1/G2/G3)	-	1/0/0	-	1/0/0
Lung infection (G2, G3)	-	0/1	-	0/1
Dermatitis (G1/G2/G3)	-	1/0/0	-	1/0/0
Febrile neutropenia (G3)	-	1	-	1
Dehydration (G1/G2/G3)	0/0/1	-	-	0/0/1

G1: Grade 1 complication; G2: Grade 2 complication; G3: Grade 3 complication; LF-IGRT: Liquid fiducial-based image-guided radiotherapy; S-IGRT: Standard image-guided radiotherapy.