Wong Hee Kam Stéphanie, Rivera Sofia, Hennequin Christophe, Lourenço Nelson, Chirica Mircea, Munoz-Bongrand Nicolas, Gornet Jean-Marc, Quéro Laurent
Radiation Oncology Department, Saint Louis Hospital, Paris, France; Radiation Oncology Department, Institut du Cancer de Montpellier, Montpellier, France.
Radiation Oncology Department, Saint Louis Hospital, Paris, France; Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
Brachytherapy. 2015 Jul-Aug;14(4):531-6. doi: 10.1016/j.brachy.2015.02.392. Epub 2015 Apr 20.
To evaluate outcomes after exclusive salvage high-dose-rate (HDR) intraluminal esophageal brachytherapy given to previously irradiated patients with recurrent esophageal cancer.
We reviewed medical records of 30 patients who were treated by salvage HDR brachytherapy for local esophageal cancer. Brachytherapy delivered four to six fractions of 5-7 Gy at 5 mm from the applicator surface and 20 mm above and below the macroscopic tumor volume.
Eighty percentage of patients received treatment as initially planned. Complete response rate, evaluated 1 month after brachytherapy by endoscopy and biopsy, was 53%. Squamous histology and complete endoscopic tumor response at 1 month were significantly associated with better local tumor control. Median local progression-free survival was 9.8 months. Overall survival was 31.5% and 17.5% at 1 and 2 years, respectively. On univariate analysis, preserved performance status and limited weight loss (<10%) before salvage brachytherapy were associated with better overall survival. Severe toxicity (Grade ≥3) occurred in 7 patients (23%).
Although esophageal cancer in previously irradiated patients is associated with poor outcomes, HDR brachytherapy may be a valuable salvage treatment for inoperable patients with locally limited esophageal cancer, particularly in the subset of patients with preserved performance status and limited weight loss (≤10%) before salvage brachytherapy.
评估对先前接受过放疗的复发性食管癌患者进行单纯挽救性高剂量率（HDR）腔内食管近距离放疗后的疗效。
我们回顾了30例接受挽救性HDR近距离放疗治疗局部食管癌患者的病历。近距离放疗在距施源器表面5毫米处以及肉眼可见肿瘤体积上下各20毫米处给予4至6次分割，每次5 - 7 Gy。
80%的患者按初始计划接受了治疗。在近距离放疗1个月后通过内镜检查和活检评估的完全缓解率为53%。鳞状组织学类型以及1个月时内镜下肿瘤完全缓解与更好的局部肿瘤控制显著相关。局部无进展生存期的中位数为9.8个月。1年和2年的总生存率分别为31.5%和17.5%。单因素分析显示，挽救性近距离放疗前保持良好的身体状况和体重减轻有限（<10%）与更好的总生存率相关。7例患者（23%）发生了严重毒性反应（≥3级）。
尽管先前接受过放疗的食管癌患者预后较差，但HDR近距离放疗对于无法手术的局部局限性食管癌患者可能是一种有价值的挽救性治疗方法，特别是对于那些在挽救性近距离放疗前身体状况良好且体重减轻有限（≤10%）的患者亚组。
