Safaei Afsaneh Maddah, Ghalehtaki Reza, Khanjani Nezhat, Farazmand Borna, Babaei Mohammad, Esmati Ebrahim
Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
J Contemp Brachytherapy. 2017 Feb;9(1):30-35. doi: 10.5114/jcb.2017.65147. Epub 2017 Jan 13.
Dysphagia is a common initial presentation in locally advanced esophageal cancer and negatively impacts patient quality of life and treatment compliance. To induce fast relief of dysphagia in patients with potentially operable esophageal cancer high-dose-rate (HDR) brachytherapy was applied prior to definitive radiochemotherapy.
In this single arm phase II clinical trial between 2013 to 2014 twenty patients with locally advanced esophageal cancer (17 squamous cell and 3 adenocarcinoma) were treated with upfront 10 Gy HDR brachytherapy, followed by 50.4 Gy external beam radiotherapy (EBRT) and concurrent chemotherapy with cisplatin/5-fluorouracil.
Tumor response, as measured by endoscopy and/or computed tomography scan, revealed complete remission in 16 and partial response in 4 patients (overall response rate 100%). Improvement of dysphagia was induced by brachytherapy within a few days and maintained up to the end of treatment in 80% of patients. No differences in either response rate or dysphagia resolution were found between squamous cell and adenocarcinoma histology. The grade 2 and 3 acute pancytopenia or bicytopenia reported in 4 patients, while sub-acute adverse effects with painful ulceration was seen in five patients, occurring after a median of 2 months. A perforation developed in one patient during the procedure of brachytherapy that resolved successfully with immediate surgery.
Brachytherapy before EBRT was a safe and effective procedure to induce rapid and durable relief from dysphagia, especially when combined with EBRT.
吞咽困难是局部晚期食管癌常见的初始表现，对患者生活质量和治疗依从性有负面影响。为使潜在可手术食管癌患者的吞咽困难迅速缓解，在确定性放化疗前应用了高剂量率（HDR）近距离放疗。
在这项2013年至2014年的单臂II期临床试验中，20例局部晚期食管癌患者（17例鳞状细胞癌和3例腺癌）接受了 upfront 10 Gy HDR近距离放疗，随后接受50.4 Gy外照射放疗（EBRT）和顺铂/5-氟尿嘧啶同步化疗。
通过内镜检查和/或计算机断层扫描测量的肿瘤反应显示，16例患者完全缓解，4例患者部分缓解（总缓解率100%）。近距离放疗在数天内使吞咽困难得到改善，80%的患者直至治疗结束时仍保持改善。鳞状细胞癌和腺癌组织学在缓解率或吞咽困难缓解方面均未发现差异。4例患者报告有2级和3级急性全血细胞减少或双血细胞减少，5例患者出现亚急性不良反应伴疼痛性溃疡，中位发生时间为2个月后。1例患者在近距离放疗过程中发生穿孔，通过立即手术成功解决。
EBRT前的近距离放疗是一种安全有效的方法，可迅速且持久地缓解吞咽困难，尤其是与EBRT联合使用时。
