title: Daytime pulsed dose rate brachytherapy as a new treatment option for previously irradiated patients with recurrent oesophageal cancer.
abstract: The aim of this study was to evaluate the feasibility, effects, and toxicity of pulsed dose rate (PDR) brachytherapy for re-irradiation of oesophageal carcinoma. A total of 16 patients (median age 67 years) with inoperable recurrences from oesophageal cancer after primary radio-(chemo)-therapy (median 50 Gy) were re-irradiated using PDR brachytherapy ((192)Ir, 37 GBq). Treatment was carried out on an outpatient basis applying a weekly 5 Gy daytime schedule (0.5 Gy pulse(-1) h(-1), total dose 15-20 Gy). The dose was prescribed 10 mm from the mid-dwell position and encompassed the clipped tumour extension with 2 cm margins. The use of clips for delineation of tumour extent and catheter movement during irradiations was evaluated. All 61 PDR treatments were applied safely. The median catheter movement was 5 mm, range 2-12 mm. After a median follow-up of 8 months, three patients had a complete and five a partial remission. Body weight increased in 5 of 16 (31%) and was stable in 4 of 16 (25%) patients, respectively. The median grade 2 (RTOG/EORTC) dysphagia-free survival was 17 months. Seven patients experienced grade 1, five grade 2, and one grade 3 late toxicity. Three patients with uncontrolled locoregional disease showed grade 4 complications (oesophago-tracheal fistulae (n=2), fatal arterial bleeding (n=1). Daytime PDR brachytherapy proved to be feasible and provided effective palliation. Toxicity remains a major problem. Thus, total dose should be restricted to <15 Gy in this palliative situation.
authors.affiliation: Department of Radiooncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Harms
authors.forename: R
authors.initials: R
authors.lastname: Krempien
authors.forename: C
authors.initials: C
authors.lastname: Grehn
authors.forename: C
authors.initials: C
authors.lastname: Berns
authors.forename: F W
authors.initials: FW
authors.lastname: Hensley
authors.forename: J
authors.initials: J
authors.lastname: Debus
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome