Procedure
tumor, primary tumors, Tumor, Cancer
DISEASE PROGRESSION, TUMOR, PRIMARY TUMORS, ADVERSE EVENT, TUMOR, ADVERSE EVENT, SURGICAL COMPLICATION, CANCER
Eligible patients received one 3-week cycle of induction treatment consisting of S-1 (40 mg/mPrior to radiotherapy, computed tomography (CT) simulation set as axial scanning with a layer thickness of 3 mm, complemented with abdominal compression, four-dimensional CT, and respiratory gating technologies, was performed to manage respiratory movement and accurately localize the target area. The gross tumor volume (GTV) included primary tumors and metastatic lymph nodes. The clinical target volume (CTV) included GTV and high-risk lymphatic drainage area. The planed target volume (PTV) included CTV with a 5-mm expansion in all direction. The radiotherapy treatment plan included a total dose of 45 Gy, typically administered in 25 fractions over five weeks. Radiotherapy was delivered using conformal, intensity-modulated, or spiral tomographic intensity-modulated techniques, with photon radiation typically at an energy level of 6 MV or 8 MV for conformal radiotherapy and 6 MV for intensity-modulated radiotherapy. The radiotherapy process was meticulously overseen by a multidisciplinary quality assurance team.A multidisciplinary team assessed the patients’ conditions and decided on the surgical protocol according to guidelinesTumor assessments were evaluated per RECIST v1.1 by CT/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) every six weeks preoperatively, every nine weeks postoperatively, and every three months after treatment completion until disease progression (up to two years) or new anticancer treatment initiation. Routine blood tests and blood biochemistry were reviewed weekly. Tumor biomarkers and thyroid function were reviewed preoperatively at weeks 3 and 8 of neoadjuvant therapy and postoperatively every 3 weeks. Adverse events (AEs) from the first dosing of the study regimen to 90 days after the last dosing were recorded and graded according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI CTCAE, version 4.03). Surgical complications were grading using Clavien-Dindo. Judgment and grading of the AEs were based on the time of occurrence of the AEs, clinical manifestations, and relevant test and examination results. If necessary, multidisciplinary discussions were held with relevant departments such as imaging, immunology, gastroenterology, and respiratory.