Kumar M U, Swamy K, Supe S S, Anantha N
Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bangalore, India.
Int J Radiat Oncol Biol Phys. 1993 Dec 1;27(5):1069-72. doi: 10.1016/0360-3016(93)90525-z.
Demonstration of the influence of intraluminal brachytherapy dose on complications in the treatment of esophageal carcinoma.
Between January 1990 and June 1991, 75 patients with esophageal cancer were treated with external radiotherapy followed by intraluminal brachytherapy. Patients had a Karnofsky score of over 70, with no supra-clavicular nodal or distant disease. An external radiotherapy dose between 40 and 55 Gy (mean 52 Gy), 5 times a week, 2 to 2.06 Gy/fraction, followed by a single session of Intraluminal brachytherapy using a locally developed, manual, afterloading applicator with Cs-137 sources with dose ranges of 8-10 Gy (Group 1: 42 patients), 10-12 Gy (Group 2: 11 patients), and 12-15 Gy (Group 3: 22 patients) at a mean dose rate of 2.09 Gy/hr was delivered.
The actuarial figures at 1 year were 39% for overall survival, 29% for disease-free survival, and 38% for local control. Fourteen patients (18.6%) developed complications of either an esophageal stricture or fistula. These were dependent on intra-luminal brachytherapy dose, whereas external radiotherapy and intra-luminal brachytherapy doses did not contribute significantly to local control. For Groups 1, 2, and 3, actuarial local control were 28%, 45%, and 63% (p < 0.1) and of complications were 6%, 20%, and 70% (p < 0.001), respectively. Also, on applying the Time/Dose/Fractionation formula on brachytherapy doses, it was found that the complication rate was 6% for TDF of < 31, 25% for TDF of 32-37, and 70% for TDF of > 38 (p < 0.001).
External radiotherapy doses in the range of 50 to 55 Gy followed by a dose of 10-12 Gy of intraluminal brachytherapy was found optimal with respect to complications and local control in the radiotherapeutic management of esophageal cancer.
证明腔内近距离放射治疗剂量对食管癌治疗中并发症的影响。
1990年1月至1991年6月期间，75例食管癌患者接受了外照射放疗，随后进行腔内近距离放射治疗。患者卡诺夫斯基评分超过70分，无锁骨上淋巴结转移或远处转移。外照射放疗剂量为40至55 Gy（平均52 Gy），每周5次，每次2至2.06 Gy，随后使用本地研发的手动后装施源器进行单次腔内近距离放射治疗，使用铯-137源，剂量范围为8 - 10 Gy（第1组：42例患者）、10 - 12 Gy（第2组：11例患者）和12 - 15 Gy（第3组：22例患者），平均剂量率为2.09 Gy/小时。
1年时的精算数据显示，总生存率为39%，无病生存率为29%，局部控制率为38%。14例患者（18.6%）出现食管狭窄或瘘管并发症。这些并发症取决于腔内近距离放射治疗剂量，而外照射放疗剂量和腔内近距离放射治疗剂量对局部控制的贡献不显著。第1组、第2组和第3组的精算局部控制率分别为28%、45%和63%（p < 0.1），并发症发生率分别为6%、20%和70%（p < 0.001）。此外，将时间/剂量/分割公式应用于近距离放射治疗剂量时，发现TDF < 31时并发症发生率为6%，TDF为32 - 37时并发症发生率为25%，TDF > 38时并发症发生率为70%（p < 0.001）。
在食管癌的放射治疗管理中，发现50至55 Gy的外照射放疗剂量后再给予10 - 12 Gy腔内近距离放射治疗，在并发症和局部控制方面是最佳的。
