Maingon P, d'Hombres A, Truc G, Barillot I, Michiels C, Bedenne L, Horiot J C
Radiotherapy Department, Centre Georges-François-Leclerc, Dijon, France.
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):71-6. doi: 10.1016/s0360-3016(99)00377-6.
We analyzed our experience with external radiotherapy, combined modality treatment, or HDR brachytherapy alone to limited esophageal cancers.
From 1991 to 1996, 25 patients with limited superficial esophagus carcinomas were treated by high dose rate brachytherapy. The mean age was 63 years (43-86 years). Five patients showed superficial local recurrence after external radiotherapy. Eleven patients without invasion of the basal membrane were staged as Tis. Fourteen patients with tumors involving the submucosa without spreading to the muscle were staged as T1. Treatment consisted of HDR brachytherapy alone in 13 patients, external radiotherapy and brachytherapy in 8 cases, and concomitant chemo- and radiotherapy in 4 cases. External beam radiation was administered to a total dose of 50 Gy using 2 Gy daily fractions in 5 weeks. In cases of HDR brachytherapy alone (13 patients), 6 applications were performed once a week.
The mean follow-up is 31 months (range 24-96 months). Twelve patients received 2 applications and 13 patients received 6 applications. Twelve patients experienced a failure (48%), 11/12 located in the esophagus, all of them in the treated volume. One patient presented an isolated distant metastasis. In the patients treated for superficial recurrence, 4/5 were locally controlled (80%) by brachytherapy alone. After brachytherapy alone, 8/13 patients were controlled (61%). The mean disease-free survival is 14 months (1-36 months). Overall survival is 76% at 1 year, 37% at 2 years, and 14% at 3 years. Overall survival for Tis patients is 24% vs. 20% for T1 (p = 0.83). Overall survival for patients treated by HDR brachytherapy alone is 43%. One patient presented with a fistula with local failure after external radiotherapy and brachytherapy. Four stenosis were registered, two were diagnosed on barium swallowing without symptoms, and two required dilatations.
High dose rate brachytherapy permits the treating of patients with superficial esophageal cancer with good tolerance. Early tumors, located in the mucosa, might be treated by HDR brachytherapy alone or by a combined modality treatment in which HDR brachytherapy can take place like a boost. This approach may cure localized recurrences.
我们分析了对局限性食管癌采用外照射放疗、综合治疗或单纯高剂量率近距离放射治疗的经验。
1991年至1996年，25例局限性表浅食管癌患者接受了高剂量率近距离放射治疗。平均年龄为63岁（43 - 86岁）。5例患者在外照射放疗后出现表浅局部复发。11例未侵犯基底膜的患者分期为Tis。14例肿瘤累及黏膜下层但未扩散至肌层的患者分期为T1。治疗包括13例单纯高剂量率近距离放射治疗、8例外照射放疗加近距离放射治疗以及4例同步放化疗。外照射放疗采用2 Gy/d，共5周，总剂量50 Gy。在单纯高剂量率近距离放射治疗的病例（13例）中，每周进行6次照射。
平均随访31个月（范围24 - 96个月）。12例患者接受2次照射，13例患者接受6次照射。12例患者出现治疗失败（48%），其中11/12位于食管，均在治疗区域内。1例患者出现孤立性远处转移。在治疗表浅复发的患者中，4/5通过单纯近距离放射治疗获得局部控制（80%）。单纯近距离放射治疗后，8/13例患者得到控制（61%）。平均无病生存期为14个月（1 - 36个月）。1年总生存率为76%，2年为37%，3年为14%。Tis患者的总生存率为24%，T1患者为20%（p = 0.83）。单纯高剂量率近距离放射治疗患者的总生存率为43%。1例患者在外照射放疗和近距离放射治疗后出现局部失败并伴有瘘管形成。记录到4例狭窄，2例在吞钡检查时无症状被诊断出，2例需要扩张治疗。
高剂量率近距离放射治疗对表浅食管癌患者耐受性良好。位于黏膜层的早期肿瘤可采用单纯高剂量率近距离放射治疗或综合治疗，其中高剂量率近距离放射治疗可作为强化治疗。这种方法可能治愈局部复发。
