Arden Cancer Centre, University Hospital, Coventry, UK.
Dis Esophagus. 2013 Jan;26(1):57-60. doi: 10.1111/j.1442-2050.2012.01333.x. Epub 2012 Mar 9.
Esophageal cancer tends to present with advanced disease, and the majority of patients are suitable only for palliative treatment at diagnosis. Dysphagia is the most common presenting symptom and significantly undermines quality of life. High-dose-rate intraluminal brachytherapy (ILBT) has been an option for the palliation of dysphagia for many years and has been used at our center since 2006. Experience was presented in terms of improvement of dysphagia and survival. Patients were identified from the local radiotherapy database. Original treatment sheets and clinical notes were reviewed retrospectively to obtain treatment details, pretreatment and post-treatment dysphagia scores, and survival information. Between January 2006 and January 2010, 21 patients of median age 77 years with a mean pretreatment dysphagia score of 2.5 underwent ILBT for esophageal cancer. All received 12 Gy in a single fraction. Thirteen (62%) had adenocarcinoma and eight (38%) squamous cell carcinoma. Four (19%) tumors were in the mid-esophagus and 17 (81%) in the lower esophagus. Eight had extension of tumor into the gastroesophageal junction. Seven patients (33%) received chemotherapy as first-line treatment prior to brachytherapy. Nineteen patients had clear documentation of dysphagia scores both pretreatment and post-treatment, and the improvement overall was significant (P= 0.04). Ten patients (53%) had an improvement in dysphagia score. Five of these (50%) went on to require further endoscopic intervention due to disease progression. Median duration of response was 4 months. Of the nonresponders, six (67%) went on to require further endoscopic intervention. No patients experienced documented toxicity aside from a short-lived acute esophagitis. Median survival from date of diagnosis was 12 months and from treatment date was 5 months (1-32 months). In our series of elderly patients with significant dysphagia, ILBT was a well-tolerated and effective treatment. It should be considered as a palliative option in esophageal cancer.
食管癌往往表现为晚期疾病，大多数患者在诊断时仅适合姑息治疗。吞咽困难是最常见的症状，严重影响生活质量。高剂量率腔内近距离放射治疗（ILBT）多年来一直是缓解吞咽困难的一种选择，自 2006 年以来在我们中心使用。本文介绍了该方法在改善吞咽困难和生存方面的经验。从当地放射治疗数据库中确定患者。回顾性查阅原始治疗表和临床记录，以获取治疗细节、治疗前和治疗后吞咽困难评分以及生存信息。2006 年 1 月至 2010 年 1 月，21 名中位年龄 77 岁、平均治疗前吞咽困难评分为 2.5 的食管癌患者接受 ILBT 治疗。所有患者均接受 12 Gy 单次分割照射。13 例（62%）为腺癌，8 例（38%）为鳞状细胞癌。4 例（19%）肿瘤位于食管中段，17 例（81%）位于食管下段。8 例肿瘤延伸至食管胃交界处。7 例（33%）患者在接受近距离放疗前接受化疗作为一线治疗。19 例患者均有治疗前和治疗后吞咽困难评分的明确记录，总体改善有显著意义（P=0.04）。10 例（53%）患者吞咽困难评分改善。其中 5 例（50%）因疾病进展需要进一步内镜干预。中位缓解持续时间为 4 个月。无反应者中，6 例（67%）需要进一步内镜干预。除短暂性急性食管炎外，无患者出现有记录的毒性反应。从诊断日期到中位生存期为 12 个月，从治疗日期到中位生存期为 5 个月（1-32 个月）。在我们的老年患者系列中，对于有明显吞咽困难的患者，ILBT 是一种耐受良好且有效的治疗方法。它应该被认为是食管癌的一种姑息治疗选择。
