Usefulness of intraluminal brachytherapy combined with external beam radiation therapy for submucosal esophageal cancer: long-term follow-up results.
OBJECTIVE
To assess the efficacy of radiation therapy (RT) by using intraluminal brachytherapy (IBT) combined with external beam RT (EBRT) for submucosal esophageal cancer.


METHODS
Between 1991 and 2005, 59 consecutive patients received definitive RT without chemotherapy. IBT was performed after patients completed EBRT as a booster therapy for 17 patients, using low-dose-rate Cs-137 sources until 1997, and for 19 patients, using high-dose-rate Ir-192 sources thereafter. The long-term outcomes were investigated with a median follow-up time of 61 months.


RESULTS
Logoregional recurrences and distant metastases were observed in 14 patients and in 2 patients in the lung, respectively, and 5 patients were rescued by salvage treatments. The 5-year logoregional control and cause-specific survival rates were 75% and 76%, respectively. The 5-year cause-specific survival rate in the EBRT group was 62%, whereas the corresponding rate in the IBT group was 86% (p = 0.04). Multivariate analysis revealed that IBT was the most powerful predictor of survival but did not reach a significant level (p = 0.07). There were five esophageal ulcers in the IBT group, but no ulcers developed with small fractions of 3 Gy. Grade 2 or higher cardiorespiratory complications developed in 2 patients (5.6%) in the IBT group and in 3 patients (13.0%) in the EBRT group.


CONCLUSIONS
Combining IBT with EBRT is suggested to be one of the preferable treatment modalities for medically inoperable submucosal esophageal cancer because of its preferable local control and survival probabilities, with appreciably less morbidity.
Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. hisikawa@med.gunma-u.ac.jp
Hitoshi
H
Ishikawa
Tetsuo
T
Nonaka
Hideyuki
H
Sakurai
Yoshio
Y
Tamaki
Yoshizumi
Y
Kitamoto
Takeshi
T
Ebara
Mariko
M
Shioya
Shin-Ei
SE
Noda
Katsuyuki
K
Shirai
Yoshiyuki
Y
Suzuki
Takeo
T
Takahashi
Takashi
T
Nakano
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002588:Cesium Radioisotopes / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D015996:Survival Rate
D002588:Cesium Radioisotopes