title: Long-term outcomes of intraluminal brachytherapy in combination with external beam radiotherapy for superficial esophageal cancer.
abstract: BACKGROUND
  The aim of this study was to assess the long-term outcomes of combining high-dose-rate intraluminal brachytherapy (IBT) with external beam radiotherapy (EBRT) for superficial esophageal cancer (SEC).
  
  
  METHODS
  From 1992 to 2002, 87 patients with T1N0M0 thoracic esophageal cancer received IBT in combination with EBRT. Of these, 44 had mucosal cancer and 43 had submucosal cancer. For patients with tumor invasion within the lamina propria mucosa, IBT alone was performed (n = 27). IBT boost following EBRT was performed for patients with tumor invasion in the muscularis mucosa or deeper (n = 60). No patient received chemotherapy.
  
  
  RESULTS
  The median follow-up time was 94 months. For mucosal cancer, the 5-year locoregional control (LRC), cause-specific survival (CSS) and overall survival (OS) rates were 75, 97 and 84%, respectively, and 49, 55 and 31%, respectively, for submucosal cancer. Tumor depth was a significant factor associated with LRC (p = 0.02), CSS (p < 0.001) and OS (p < 0.001) by univariate analysis. Multivariate analysis revealed that tumor depth was the only significant predictor for OS (p = 0.003). Late toxicities of grade 3 or higher in esophagus, pneumonitis, pleural effusion and pericardial effusion were observed in 5, 0, 0 and 1 patients, respectively. Grade ≥3 events of cardiac ischemia and heart failure after radiotherapy were observed in 9 patients, and history of heart disease before radiotherapy was the only significant factor (p = 0.002).
  
  
  CONCLUSIONS
  There was a clear difference in outcomes of IBT combined with EBRT between mucosal and submucosal esophageal cancers. More intensive treatment should be considered for submucosal cancer.
authors: Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. yujimura@hiroshima-u.ac.jp
authors: Yuji
authors: Y
authors: Murakami
authors: Yasushi
authors: Y
authors: Nagata
authors: Ikuno
authors: I
authors: Nishibuchi
authors: Tomoki
authors: T
authors: Kimura
authors: Masahiro
authors: M
authors: Kenjo
authors: Yuko
authors: Y
authors: Kaneyasu
authors: Tomoyuki
authors: T
authors: Okabe
authors: Yasutoshi
authors: Y
authors: Hashimoto
authors: Yukio
authors: Y
authors: Akagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome