Yorozu A, Dokiya T, Oki Y
Department of Radiology, National Tokyo Medical Center, Japan.
Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):271-5. doi: 10.1016/s0360-3016(99)00184-4.
To assess the efficacy, toxicity, and the optimum dose of high-dose-rate brachytherapy following chemoradiotherapy (CRT) compared with a historical group of patients treated with a combination of external beam and brachytherapy (RT alone).
Fifty-three patients with localized esophageal cancer received concurrent chemoradiotherapy followed by brachytherapy. The chemotherapy regimen was a combination of cisplatin 60 mg/m2 on day 1 and fluorouracil 600 mg/m2 continuous infusion from days 1-4 during the first and last week of external irradiation. Radiotherapy consisted of external irradiation to a total dose of 40-61 Gy (median 50 Gy) and brachytherapy to 8-24 Gy (median 16 Gy) in 2-4 fractions.
Acute toxicity was well tolerated. A fistula occurred in one patient 1 week after completion of external irradiation. Local control was achieved in 32/53 (60%) compared with 42% of the RT group (p = 0.029). Local control rates of the CRT group were significantly better than those of the RT group in Stages II and III. Late toxicity (esophageal ulceration and strictures) occurred in 18 (34%) of the CRT group compared with 12% in the RT group (p = 0.013). Severe late toxicity (RTOG/EORTC criteria Grade 3-4) occurred in six patients (15%) whose chemotherapy was followed by 16-24 Gy via brachytherapy compared with 2.5% in the RT group (p = 0.010).
Combined chemoradiotherapy and brachytherapy boost achieved better local control than radiotherapy alone. However, a high level of severe late toxicity was observed especially with 16-24 Gy via brachytherapy.
评估与一组接受外照射和近距离放射治疗联合治疗（单纯放疗）的历史患者相比，放化疗（CRT）后高剂量率近距离放射治疗的疗效、毒性和最佳剂量。
53例局部食管癌患者接受同步放化疗，随后进行近距离放射治疗。化疗方案为在第1天给予顺铂60mg/m²，在体外照射的第一周和最后一周的第1 - 4天持续输注氟尿嘧啶600mg/m²。放射治疗包括体外照射总剂量为40 - 61Gy（中位剂量50Gy），近距离放射治疗剂量为8 - 24Gy（中位剂量16Gy），分2 - 4次进行。
急性毒性耐受性良好。1例患者在体外照射完成后1周出现瘘管。53例患者中有32例（60%）实现了局部控制，而单纯放疗组为42%（p = 0.029）。CRT组在II期和III期的局部控制率明显优于单纯放疗组。CRT组有18例（34%）出现晚期毒性（食管溃疡和狭窄），而单纯放疗组为12%（p = 0.013）。6例患者（15%）在化疗后接受16 - 24Gy的近距离放射治疗出现严重晚期毒性（根据RTOG/EORTC标准为3 - 4级），而单纯放疗组为2.5%（p = 0.010）。
放化疗联合近距离放射治疗增敏比单纯放疗能更好地实现局部控制。然而，尤其是接受16 - 24Gy近距离放射治疗时，观察到严重晚期毒性的发生率较高。
