Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Int J Clin Oncol. 2012 Jun;17(3):263-71. doi: 10.1007/s10147-011-0285-4. Epub 2011 Jul 12.
The aim of this study was to assess the long-term outcomes of combining high-dose-rate intraluminal brachytherapy (IBT) with external beam radiotherapy (EBRT) for superficial esophageal cancer (SEC).
From 1992 to 2002, 87 patients with T1N0M0 thoracic esophageal cancer received IBT in combination with EBRT. Of these, 44 had mucosal cancer and 43 had submucosal cancer. For patients with tumor invasion within the lamina propria mucosa, IBT alone was performed (n = 27). IBT boost following EBRT was performed for patients with tumor invasion in the muscularis mucosa or deeper (n = 60). No patient received chemotherapy.
The median follow-up time was 94 months. For mucosal cancer, the 5-year locoregional control (LRC), cause-specific survival (CSS) and overall survival (OS) rates were 75, 97 and 84%, respectively, and 49, 55 and 31%, respectively, for submucosal cancer. Tumor depth was a significant factor associated with LRC (p = 0.02), CSS (p < 0.001) and OS (p < 0.001) by univariate analysis. Multivariate analysis revealed that tumor depth was the only significant predictor for OS (p = 0.003). Late toxicities of grade 3 or higher in esophagus, pneumonitis, pleural effusion and pericardial effusion were observed in 5, 0, 0 and 1 patients, respectively. Grade ≥3 events of cardiac ischemia and heart failure after radiotherapy were observed in 9 patients, and history of heart disease before radiotherapy was the only significant factor (p = 0.002).
There was a clear difference in outcomes of IBT combined with EBRT between mucosal and submucosal esophageal cancers. More intensive treatment should be considered for submucosal cancer.
本研究旨在评估高剂量率腔内近距离放疗（IBT）联合外照射放疗（EBRT）治疗表浅食管癌（SEC）的长期疗效。
1992 年至 2002 年，87 例 T1N0M0 胸段食管鳞癌患者接受了 IBT 联合 EBRT 治疗。其中，44 例为黏膜癌，43 例为黏膜下癌。对于肿瘤侵犯固有层黏膜的患者，单独行 IBT（n=27）。对于肿瘤侵犯黏膜肌层或更深层的患者，在 EBRT 后行 IBT 加量（n=60）。所有患者均未接受化疗。
中位随访时间为 94 个月。对于黏膜癌，5 年局部区域控制率（LRC）、疾病特异性生存率（CSS）和总生存率（OS）分别为 75%、97%和 84%，而对于黏膜下癌，这 3 项指标分别为 49%、55%和 31%。肿瘤深度是影响 LRC（p=0.02）、CSS（p<0.001）和 OS（p<0.001）的单因素分析中的显著因素。多因素分析显示，肿瘤深度是 OS 的唯一显著预测因素（p=0.003）。5 例患者出现 3 级或以上食管、肺炎、胸腔积液和心包积液的迟发性毒性反应，0 例患者出现 3 级或以上放射性肺损伤，0 例患者出现 3 级或以上胸腔积液和心包积液。9 例患者在放疗后出现 3 级或以上的心脏缺血和心力衰竭事件，且放疗前有心脏病史是唯一的显著因素（p=0.002）。
IBT 联合 EBRT 治疗食管黏膜癌和黏膜下癌的疗效存在明显差异。对于黏膜下癌，应考虑更强化的治疗。
