الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The upper GIT and pancreatic are the most common sites of malignant lesions, with higher incidence and mortality rates. These tumors are often diagnosed at an advanced stage due to the non-specific symptoms. Despite the various methods of diagnosis and multimodality treatment, the prognosis is still poor.
The management of upper GIT and pancreatic malignancy are a multidisciplinary team based on the decision. Treatments usually are multi-therapy it could be surgery, chemotherapy, target therapy, and radiation therapy.
Even though there are a lot of challenges on delivery radiotherapy in upper GIT and pancreatic malignancies, still radiation therapy remains one of the current cornerstones in the management. It may be used in neoadjuvant, definitive, adjuvant and palliative settings, either in isolation or as a multimodal approach.
The present work was carried out prospectively and purposed to evaluate the dosimetric effect of gastric filling on the motion of targets and organs at risk in patients with upper gastrointestinal and pancreatic cancers receiving radiotherapy. To achieve this aim, the present study included 30 patients that had upper GIT and pancreatic cancers and received radiation therapy.
This study was conducted at the Clinical Oncology Department in Alexandria University and Specialized Universal Network of Oncology between December 2019 and May 2021.
Our demographic data was a total of 30 participants, 21 were males and 9 were females. Their mean age was 57.1 years (range 28-78). 76.67% of patients had comorbidities, of which 48% of patients had hypertension, while diabetic Mellitus and hepatitis C virus accounted for the same percentage 39%. The most common diagnosis was hepatocellular carcinoma – 33%, followed by gastric adenocarcinoma – 27%. Twelve (40%) patients had stage III disease, while 36.66% were stage II. and stage IVA was encountered in 7 patients.
Among the 30 patients, 12 patients underwent surgery. 58.33% underwent subtotal gastrectomy, 33% - total gastrectomy, and 8% - pancreatectomy. All 30 patients were irradiated and the majority of the 12 (40.00%) had adjuvant radiation therapy. Out of 30 patients, 21 patients had combination chemo-radiotherapy of which 71.42% was concurrent chemoradiation. The dose of radiation therapy ranged from 20Gy to 45Gy.
In the current study, the minimum amount of water taken by the patients was 50 ml, and the maximum amount was 1000 ml. There were significant differences in the mean volume between empty and full stomachs (216 cm3 vs 557 cm3 respectively, p < 0.001).
This study noted that gastric filling variation (empty and full) there were no significant differences in the maximum dose and mean dose of target volumes covered (GTV, CTV and PTV). However on some organs at risk showed significant differences in the maximum dose of the esophagus (p=0.021), the right kidney (p=0.01) and the heart (p=0.041), on an empty and full stomach. The mean dose to the esophagus and right kidney was higher in the full stomach while to the heart was higher on empty stomach.
Also in the Dmean, was found that the 4 organs at risk showed that significant differences of an empty and full stomach, the bowel (p=0.01), the right kidney (p=0.034), the right lung (p=0.009), and the stomach (p=0.007). The mean dose to the bowel, stomach and right lung was higher in an empty stomach while to the right kidney was higher in a full stomach. While no significant differences in target volumes were elicited whether the stomach was empty or full