Gava A, Fontan L, Bolner A, Botturi M, Cafaro I, Di Marco A, Marazzato G, Muto P, Orecchia R, Orsatti M, Parisi S S, Rigon A
Istituto Radioterapia Oncologica, Ospedale di Treviso.
Radiol Med. 1996 Jan-Feb;91(1-2):118-21.
The results are reported of HDR intracavitary brachytherapy in 134 esophageal carcinoma patients (110 men and 24 women) treated in 10 Italian centers. Forty-one patients received radical treatment and brachytherapy was often combined with external irradiation and/or chemotherapy. Clinical response rates follow: 56% complete remissions, 34% partial remissions, 10% no response/disease progression and not assessed. Ninety-three patients underwent palliative treatment: dysphagia was reduced in 80% of them and pain was reduced in 71% of them. Treatment-induced esophageal damage consisted in G3-G4 esophagitis (5% of patients), strictures (10%) and fistulas (3%). Complication rates were correlated with fraction dose (9.5% complications for fraction doses < 500 cGy, 20% with doses ranging 500-800 cGy and 38% with fraction doses > 800 cGy). Moreover, the esophagus was more severely injured when small tubes were used (24% with tubes phi < 2 mm, 19% with tubes phi 2-6 mm and 5% with tubes phi > 6 mm). When external irradiation was combined with brachytherapy, dysphagia was more relieved than with brachytherapy alone (89% vs. 71%), with no increase in complication rates. Also the chemotherapy-brachytherapy combination improved swallowing more than brachytherapy alone (88% vs. 79%) and once again complication rates did not increase. To conclude, in the radical treatment of esophageal carcinoma, HDR brachytherapy permits higher radiation doses to be delivered, with fair complication rates. As for palliative treatment, HDR brachytherapy is safe, has low morbidity and provides adequate relief of dysphagia in 80% of patients. We suggest the use of tubes phi > 6 mm and fraction doses ranging 5-6 Gy.
本文报告了意大利10个中心对134例食管癌患者（110例男性，24例女性）进行高剂量率腔内近距离放疗的结果。41例患者接受了根治性治疗，近距离放疗常与外照射和/或化疗联合使用。临床缓解率如下：完全缓解率为56%，部分缓解率为34%，无缓解/疾病进展率为10%（未评估）。93例患者接受了姑息性治疗：其中80%的患者吞咽困难得到缓解，71%的患者疼痛得到缓解。治疗引起的食管损伤包括3 - 4级食管炎（5%的患者）、狭窄（10%）和瘘管（3%）。并发症发生率与分次剂量相关（分次剂量<500 cGy时并发症发生率为9.5%，500 - 800 cGy时为20%，分次剂量>800 cGy时为38%）。此外，使用小直径导管时食管损伤更严重（导管直径<2 mm时为24%，2 - 6 mm时为19%，>6 mm时为5%）。当外照射与近距离放疗联合使用时，吞咽困难的缓解程度比单纯近距离放疗更明显（89%对71%），且并发症发生率没有增加。化疗与近距离放疗联合使用时吞咽功能的改善也比单纯近距离放疗更显著（88%对79%），并发症发生率同样没有增加。总之，在食管癌的根治性治疗中，高剂量率近距离放疗能够给予更高的辐射剂量，且并发症发生率尚可。对于姑息性治疗，高剂量率近距离放疗安全、发病率低，80%的患者吞咽困难能得到充分缓解。我们建议使用直径>6 mm的导管，分次剂量为5 - 6 Gy。
