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KMID : 0377220020270020042
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Medical Journal of Chosun Univercity
2002 Volume.27 No. 2 p.42 ~ p.50
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Combined modality of external radiotherapy and brachytherapy in patients with esophageal carcinoma
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Nam Taek-Keun
Nah Byung-Sik
Oh Yoon-Kyeong
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Abstract
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Background and Objectives: To evaluate the role of brachytherapy following external radiotherapy by retrospective analysis in view of survival and prognostic factors in esophageal carcinoma.
Materials and Methods: From Apr. 1999 to Dec. 2000, a total of 28 patients, who were diagnosed as esophageal carcinoma, were treated by curative external radiotherapy followed by brachytherapy with or without chemotherapy. Eligible primary tumors were located in the thoracic esophagus and lymphatic metastases were restricted to supraclavicular or mediastinal nodes. External radiotherapy was performed by 6 MV or 10 MV X-ray and the range of doses was 50.0 Gy - 59.4 Gy (median; 54.9) to primary tumors. One week later, the intraluminal brachtherapy (IB) was performed by high-dose rate remote controlled afterloader with radioisotope of ^192Ir. Fraction size of IB was 2~5 Gy, twice a week and delivered up to total doses of 3 Gy~ 20 Gy (median; 12). Twenty-one patients were treated by concurrent chemotherapy with the agents of cisplatin and 5-FU. Cisplatin, 75 ㎎/㎡, was given on the first day of weeks 1, 5, 8, 11 and 5-FU, 1,000 ㎎/㎡, was administered as a continuous infusion for the first 4 days of each course.
Results: The estimated median survival time was 15 months and 1, 2, 3-year survival rates were 60.7%, 27.5%, 9.2%, respectively. The median survival time (MST) of the patients with stage II (n=9), III (n=17), IVA (n=2) were 20, 15, 5 months, respectively (p=0.68). The MST of the patients with complete response vs partial response were 21 vs 14 months, respectively (p=0.12). The MST of patients younger than 60 years vs older were 22 vs 12 months, respectively (p=0.07). The MST of patients with ECOG performance index 1 vs 2 were 16 vs 10 months, respectively (P=0.06) Tile Mn of patients treated by concurrent chemotherapy vs untreated were 20 vs 12 months, respectively (p=0.07). Four patients (14.3%) suffered massive hematemesis after brachytherapy and one patient with local recurrence salvaged by esophagectomy had mediastinal abscess. Of 21 patients treated by concurrent chemoradiothetapy, one patient had pancytopenia and other two patients had severe leukopenia.
Conclusion: This study showed no better outcomes of brachytherapy boost after external radiotherapy than historical results of external radiotherapy alone. Concurrent chemotherapy might have more significant therapeutic role rather than brachytherapy boost and the employment of brachythelapy should be considered with great caution in the treatment of esophageal carcinoma.
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KEYWORD
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esophageal carcinoma, concurrent chemoradiotherapy, brachytherapy, survival
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