title: Esophageal gel-shifting technique facilitating eradicative boost or reirradiation to upper mediastinal targets of recurrent nerve lymph node without damaging esophagus.
abstract: We developed a new technique using hyaluronic gel injection as a spacer to safely move the esophagus away from the high-dose area during interstitial brachytherapy of a mediastinal target close to the esophagus. We percutaneously injected a high-molecular-weight hyaluronic gel mixed with contrast medium to create a space between the esophagus and the target during interstitial brachytherapy. We applied this technique to two cases of relapsed recurrent nerve lymph node metastasis from esophageal cancer: one refractory tumor after 50 Gy of radiotherapy, and one recurrence after mediastinal radiotherapy of total 64 Gy. We prescribed 20 Gy and 18 Gy in one fraction to each target, with calculated esophageal D2cc (the minimum dose to the most irradiated volume of 2 cc) of 4.0 Gy and 6.8 Gy, respectively. Calculated enhancement factor by gel shifting in equivalent dose was 2.69 and 2.34, respectively. In each patient, accumulated esophageal D1cc (minimum dose to the most irradiated volume of p cc. minimum dose to the most irradiated volume of 1 cc) was 74.4 Gy and 85.6 Gy without shifting, and 59.1 Gy and 37.6 Gy with shifting, respectively. There were no procedure-related complications. Four months after the brachytherapy, each tumor was remarkably diminished. No evidence of recurrences or late complications were observed 8 months and 9 months after the procedure, respectively. The esophageal gel-shifting technique may facilitate eradicative brachytherapy to upper mediastinal targets without damaging the esophagus, and can be used in conjunction with boost irradiation or reirradiation to overcome the problem of salvage failure.
authors: Department of Radiation Oncology, Wakayama Medical University, Wakayama City, 64-8510 Japan.
authors: Kazushi
authors: K
authors: Kishi
authors: Takeshi
authors: T
authors: Iida
authors: Toshiyasu
authors: T
authors: Ojima
authors: Tetsuo
authors: T
authors: Sonomura
authors: Shintaro
authors: S
authors: Shirai
authors: Motoki
authors: M
authors: Nakai
authors: Morio
authors: M
authors: Sato
authors: Hiroki
authors: H
authors: Yamaue
mesh_terms: D000368:Aged; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D003287:Contrast Media / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004938:Esophageal Neoplasms / Q000532:radiotherapy*; D004947:Esophagus / Q000033:anatomy & histology / Q000528:radiation effects; D005782:Gels / Q000737:chemistry; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry; D008198:Lymph Nodes / Q000473:pathology* / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011832:Radiation Injuries / Q000517:prevention & control; D011878:Radiotherapy / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted; D012008:Recurrence; D012009:Recurrent Laryngeal Nerve / Q000528:radiation effects; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D005782:Gels; D006820:Hyaluronic Acid
keywords: boost; esophageal cancer; hyaluronate; recurrent nerve lymph node, risk organ, toxicity; reirradiation; spacer, brachytherapy