Efficacy of intracavitary brachytherapy for recurrent esophageal cancer after radiotherapy
Sun Yunchuan,Tian Dandan,Bi Jianqiang,Yuan Xiangkun,Shi Fumin,Hu Zhiwei,HuJianwei,Wang Junjie
Department of Radiotherapy,Cangzhou Integrated Traditional Chinese and Western Medicine Hospital,Cangzhou 061000,China (Sun YC,Tian DD,Bi JQ,Yuan XK,Shi FM,Hu ZW,Hu JW); Third Affiliated Hospital of Peking University,Beijing 100191,China (Wang JJ)
Abstract： Objective To discuss the preliminary efficacy and adverse reactions of intracavitary brachytherapy in the treatment of loco-regional recurrent (LR) esophageal cancer after radiotherapy. Methods Iridium-192 brachytherapy was used to carry out intracavitary radiotherapy for 18 patients with LR esophageal cancer after initial radiotherapy from 2009 to 2013. A total irradiation dose of 16-30 Gy was given in 4-6 fractions (4-5 Gy per fraction). Intracavitary irradiation covered the lesion plus 1.0 cm upper and lower margins. The zero reference point was 10 mm far from the axis. Short-term efficacy, local control (LC) rate, overall survival (OS) rate, and adverse reactions were evaluated. Results In the 18 patients, the follow-up rate was 100%;the overall response rate was 94%,with a complete response rate of 3/18, a partial response rate of 14/18, and a no response rate of 1/18. In 16 patients with clinical symptoms on admission, 13 showed remission (6 had symptoms disappearing and 7 had symptoms alleviated), 2 remained the same, and 1 got worse after treatment, yielding an overall clinical remission rate of 81%. In all the 18 patients, 6 patients had grade ≥2 radiation esophagitis (RE), consisting of 4 with grade 2 RE and 2 with grade 3 RE.One patient with esophageal stricture at 5 months after radiotherapy received gastric fistula surgery. The median time to LC was 14 months (3-38 months). The 1-, 2-, and 3-year LC rates were 72%, 44%, and 33%, respectively. The 1-, 2-, and 3-year OS rates were 61%, 22%, and 17%, respectively. The median OS time was 12 months (5.5-45.0 months). Fourteen deaths occurred in those patients, consisting of 12 cancer-related deaths and 2 non-cancer-related deaths. Conclusions Intracavitary brachytherapy achieves satisfactory efficacy and significantly improves the symptoms in the treatment of LR after radiotherapy for esophageal cancer.
Sun Yunchuan,Tian Dandan,Bi Jianqiang et al. Efficacy of intracavitary brachytherapy for recurrent esophageal cancer after radiotherapy[J]. Chinese Journal of Radiation Oncology, 2016, 25(12): 1305-1309.
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