title: Comparison of efficacy and safety of low-dose-rate vs. high-dose-rate intraluminal brachytherapy boost in patients with superficial esophageal cancer.
abstract: OBJECTIVE
  To compare the efficacy and the incidence of complications of high-dose-rate (HDR) and low-dose-rate (LDR) intraluminal brachytherapy (IBT) boost after external beam radiation therapy in patients with superficial esophageal cancer.
  
  
  METHODS
  Fifty-four consecutive patients with Stage I thoracic esophageal squamous cell carcinoma who were treated with definitive radiotherapy using IBT between 1991 and 2007 were studied retrospectively. LDR-IBT and HDR-IBT were performed for 19 and 35 patients, respectively. After external beam radiation therapy of 56-60 Gy with a conventional fractionation, LDR-IBT (5 Gy × 2) or HDR-IBT (3 Gy × 3) was given within 2 weeks. The median follow-up was 47 months (7-151 months).
  
  
  RESULTS
  Overall, the 5-year overall survival, cause-specific survival (CSS), and locoregional control (LRC) rates were 61%, 86%, and 79%, respectively. The 5-year overall survival, CCS, and LRC rates did not differ significantly between the LDR-IBT and HDR-IBT groups (68% vs. 58% (p=0.50), 83% vs. 85% (p=0.63), and 84% vs. 75% (p=0.42), respectively). Salvage treatment was given in 8 locally recurrent patients, and 6 patients were rescued. The Grade ≥2 late morbidities of esophagus and heart/lung were observed in 5 patients (4 in the LDR-IBT group and 1 in the HDR-IBT group) and 2 patients (one from each group), respectively.
  
  
  CONCLUSIONS
  In view of the safety profile and effectiveness, our results encourage the continued adoption of HDR-IBT as radiation boost in medically inoperable or elderly superficial esophageal cancer patients undergoing definitive radiotherapy.
authors.affiliation: Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan. tamakit@med.gunma-u.ac.j
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Tamaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Takeo
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tamaki
authors.forename: Yoshizumi
authors.initials: Y
authors.lastname: Kitamoto
authors.forename: Masahiko
authors.initials: M
authors.lastname: Okamoto
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Noda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Katoh
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Shirai
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D018307:Neoplasms, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis