USEFULNESS OF INTRALUMINAL BRACHYTHERAPY COMBINED WITH EXTERNAL BEAM RADIATION THERAPY FOR SUBMUCOSAL ESOPHAGEAL CANCER: LONG-TERM FOLLOW-UP RESULTS

作者：Ishikawa Hitoshi^*; Nonaka Tetsuo; Sakurai Hideyuki; Tamaki Yoshio; Kitamoto Yoshizumi; Ebara Takeshi; Shioya Mariko; Noda Shin Ei; Shirai Katsuyuki; Suzuki Yoshiyuki; Takahashi Takeo; Nakano Takashi

来源：International Journal of Radiation Oncology, Biology, Physics, 2010, 76(2): 452-459.

DOI：10.1016/j.ijrobp.2009.02.029

• Radiation therapy
• Brachytherapy
• Esophageal cancer
• Survival
• Prognostic factor

Purpose: To assess the efficacy of radiation therapy (RT) by using intraluminal brachytherapy (IBT) combined with external beam RT (EBRT) for submucosal esophageal cancer.
Methods and Materials: Between 1991 and 2005,59 consecutive patients received definitive RT without chemotherapy. IBT was performed after patients completed EBRT as a booster therapy for 17 patients, using low-dose-rate Cs-137 sources until 1997, and for 19 patients, using high-dose-rate Ir-192 sources thereafter. The long-term outcomes were investigated with a median follow-up time of 61 months.
Results: Logoregional recurrences and distant metastases were observed in 14 patients and in 2 patients in the lung, respectively, and 5 patients were rescued by salvage treatments. The 5-year logoregional control and cause-specific survival rates were 75% and 76%, respectively. The 5-year cause-specific survival rate in the EBRT group was 62%, whereas the corresponding rate in the IBT group was 86% (p=0.04). Multivariate analysis revealed that IBT was the most powerful predictor of survival but did not reach a significant level (p=0.07). There were five esophageal ulcers in the IBT group, but no ulcers developed with small fractions of 3 Gy. Grade 2 or higher cardiorespiratory complications developed in 2 patients (5.6%) in the IBT group and in 3 patients (13.0%) in the EBRT group.
Conclusions: Combining IBT with EBRT is suggested to be one of the preferable treatment modalities for medically inoperable submucosal esophageal cancer because of its preferable local control and survival probabilities, with appreciably less morbidity.

• 出版日期2010-2-1