Long-term results of concurrent chemoradiotherapy followed by high dose rate brachytherapy for T2-3 N0-1 M0 esophageal carcinoma

被引：0

作者：

Yorozu A. ^{[1
]}

Toya K. ^{[1
]}

Dokiya T. ^{[1
]}

机构：

[1] Department of Radiology, Tokyo Medical Center, National Hospital Organization, Meguro-ku, Tokyo 152-8902

来源：

Esophagus | 2006年 / 3卷 / 1期

关键词：

Brachytherapy; Chemoradiotherapy; Esophageal carcinoma; Toxicity;

D O I：

10.1007/s10388-006-0073-9

中图分类号：

学科分类号：

摘要：

Background. To assess the long-term efficacy and the pattern of failure of concurrent chemoradiotherapy followed by high dose rate (HDR) brachytherapy for stage T2-3 N0-1 M0 esophageal carcinoma. Methods. Forty-six patients with clinical stage T2-3 N0-1 M0 esophageal cancer received concurrent chemoradiotherapy followed by HDR brachytherapy. The chemotherapy regimen was a combination of cisplatin 60 mg/m2 on day 1 and fluorouracil 600 mg/m2 continuous infusion from days 1 to 4 during the first and last week of external-beam irradiation. Radiotherapy consisted of external beam to a total dose of 40-60 Gy (median, 50 Gy) and high dose rate brachytherapy to 8-24 Gy (median, 16 Gy) in 2-4 fractions. External beam was delivered to a field of the primary lesion and the involved nodal lesions. All patients were followed up for at least 5 years. Results. The 5-year overall survival rate was 28%. The median survival duration was 22 months. The 5-year cause-specific survival rate was 34% and the median was 22 months. Persistent disease was found in 7 of 46 patients (15%). Of the 39 patients with initial complete tumor disappearance, locoregional failure occurred ultimately in 13 patients. The ultimate local control rate was 57% (26/46). Three patients were salvaged successfully with surgery. Four patients (9%) had regional recurrence out of the irradiated fields as first failure site. Four patients (9%) had recurrence 3 years or longer after treatment. Twelve patients had transient ulcers, which healed spontaneously within a few months. Massive esophageal bleeding, thought to be treatment related, occurred in 2 patients, leading to death. Severe late toxicity with esophageal ulceration was found in patients receiving a dose of 16-24 Gy via brachytherapy. Conclusions. Concurrent chemoradiotherapy followed by HDR brachytherapy achieved long-term effective and curative results for stage T2-3 N0-1 M0 esophageal carcinoma. However, severe late toxicity was observed with 16-24 Gy via brachytherapy. We recommend a dose via HDR brachytherapy should be 12 Gy or less following concurrent chemoradiotherapy. © Japan Esophageal Society and Springer-Verlag 2006.

引用

页码：1 / 5

页数：4

共 11 条

[1]

Cooper J.S., Guo M.D., Herskovic A., MacDonald J.S., Martenson J.A., Al-Sarraf M., Et al., Chemoradiotherapy of locally advanced esophageal cancer: Long-term follow-up of a prospective randomized trial (RTOG085-01), JAMA, 281, pp. 1623-7, (1999)

[2]

Hironaka S., Ohtsu A., Boku N., Muto M., Nagashima F., Saito H., Et al., Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2-3)N(any)M(0) squamous cell carcinoma of the esophagus, Int J Radiat Oncol Biol Phys, 57, pp. 425-33, (2003)

[3]

Okawa T., Dokiya T., Nishio M., Hishikawa Y., Morita K., Multi-institutional randomized trial of external radiotherapy with and without intraluminal brachytherapy for esophageal cancer in Japan. Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group, Int J Radiat Oncol Biol Phys, 45, pp. 623-8, (1999)

[4]

Sur R.K., Levin C.V., Donde B., Sharma V., Miszczwk L., Nag S., Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma: An International Atomic Energy Agency study, Int J Radiat Oncol Biol Phys, 53, pp. 127-33, (2002)

[5]

Gaspar L.E., Winter K., Kocha W.I., Coia L.R., Herskovic A., Graham M., A phase I/II study of external beam radiation, brachytherapy, and concurrent chemoradiotherpy for patients with localized carcinoma of the esophagus (RTOG 9207): Final report, Cancer (Phila), 88, pp. 988-95, (2000)

[6]

Minsky B.D., Pajak T.F., Ginsberg R.J., Pisansky T.M., Martenson J., Komaki R., Et al., INT 0123 (Radiation Therapy Oncology Group 94-05) Phase III trial of combined-modality therapy for esophageal cancer: High-dose versus standard-dose radiation therapy, J Clin Oncol, 20, pp. 1167-74, (2002)

[7]

Yorozu A., Dokiya T., Oki Y., High-dose-rate brachytherapy boost following concurrent chemoradiotherapy for esophageal carcinoma, Int J Radiat Oncol Biol Phys, 45, pp. 271-5, (1999)

[8]

TNM Classification of Malignant Tumors 6th Ed., (2002)

[9]

Yorozu A., Dokiya T., Oki Y., Suzuki T., Curative radiotherapy with high-dose-rate brachytherapy boost for localized esophageal carcinoma: Dose-effect relationship of brachytherapy with the balloon type applicator system, Radiother Oncol, 51, pp. 133-9, (1999)

[10]

Calais G., Dorval E., Louisot P., Bourlier R., Klein V., Chapet S., Et al., Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for stages IIB and III esophageal carcinoma: Results of a pilot study, Int Radiat Oncol Biol Phys, 38, pp. 769-75, (1997)

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