Skip to main content
SpringerLink
Log in

Long-term outcomes of intraluminal brachytherapy in combination with external beam radiotherapy for superficial esophageal cancer

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Okawa T, Tanaka M, Kita M et al (1995) Superficial esophageal cancer: multicenter analysis of results of definitive radiation therapy in Japan. Radiology 196:271–274

    PubMed  CAS  Google Scholar 

  2. (2002) Comprehensive registry of Esophageal Cancer in Japan (1998, 1999) and long term results of esophagectomy in Japan (1988–1997), 3rd edn. The Japanese Society for Esophageal Disease

  3. Murakami Y, Kenjo M, Uno T et al (2007) Results of the 1999–2001 Japanese patterns of care study for patients receiving definitive radiation therapy without surgery for esophageal cancer. Jpn J Clin Oncol 37:493–500

    Article  PubMed  Google Scholar 

  4. Kodama M, Kakegawa T (1998) Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan. Surgery 123:432–439

    Article  PubMed  CAS  Google Scholar 

  5. Endo M, Yoshino K, Kawano T et al (2000) Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus 13:125–129

    Article  PubMed  CAS  Google Scholar 

  6. Bollschweiler E, Baldus SE, Schröder W et al (2006) High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 38:149–156

    Article  PubMed  CAS  Google Scholar 

  7. Makuuchi H, Shimada H, Mizutani K et al (1997) Clinical pathological analysis of surgically resected superficial esophageal carcinoma to determine criteria for deciding on treatment strategy. Diagn Ther Endosc 3:211–220

    Article  PubMed  CAS  Google Scholar 

  8. Nishimaki T, Tanaka O, Suzuki T et al (1993) Tumor spread in superficial esophageal cancer: histopathologic basis for rational surgical treatment. World J Surg 17:766–772

    Article  PubMed  CAS  Google Scholar 

  9. Tachibana M, Yoshimura H, Kinugasa S et al (1997) Clinicopathological features of superficial squamous cell carcinoma of the esophagus. Am J Surg 174:49–53

    Article  PubMed  CAS  Google Scholar 

  10. Nemoto K, Yamada S, Mitsuhashi N et al (2001) Radiation therapy for superficial esophageal cancer: a comparison of radiotherapy methods. Int J Radiat Oncol Biol Phys 50:639–644

    Article  PubMed  CAS  Google Scholar 

  11. Nemoto K, Yamada S, Nishio M et al (2006) Results of radiation therapy for superficial esophageal cancer using the standard radiotherapy method recommended by the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group. Anticancer Res 26:1507–1512

    PubMed  Google Scholar 

  12. Shioyama Y, Nakamura K, Sasaki T et al (2005) Clinical results of radiation therapy for stage I esophageal cancer A single institutional experience. Am J Clin Oncol 28:75–80

    Article  PubMed  Google Scholar 

  13. Ishikawa H, Sakurai H, Yamakawa M et al (2005) Clinical outcomes and prognostic factors for patients with early esophageal squamous cell carcinoma treated with definitive radiation therapy alone. J Clin Gastroenterol 39:495–500

    Article  PubMed  Google Scholar 

  14. Sai H, Mitsumori M, Araki N et al (2005) Long-term results of definitive radiotherapy for stage I esophageal cancer. Int J Radiat Oncol Biol Phys 62:1339–1344

    Article  PubMed  Google Scholar 

  15. Hareyama M, Nishio M, Kagami Y et al (1992) Intracavitary brachytherapy combined with external-beam irradiation for squamous cell carcinoma of the thoracic esophagus. Int J Radiat Oncol Biol Phys 24:235–240

    Article  PubMed  CAS  Google Scholar 

  16. Okawa T, Dokiya T, Nishio M et al (1999) Multi-institutional randomized trial of external radiotherapy with or without intraluminal brachytherapy for esophageal cancer in Japan. Int J Radiat Oncol Biol Phys 45:623–628

    Article  PubMed  CAS  Google Scholar 

  17. Yorozu A, Dokiya T, Oki Y (1999) High-dose-rate brachytherapy boost following concurrent chemoradiotherapy for esophageal carcinoma. Int J Radiat Oncol Biol Phys 50:271–275

    Article  Google Scholar 

  18. Maingon P, Hombres A, Truc G et al (2000) High dose rate brachytherapy for superficial cancer of the esophagus. Int J Radiat Oncol Biol Phys 46:71–76

    Article  PubMed  CAS  Google Scholar 

  19. Ishikawa H, Nonaka T, Sakurai H et al (2010) Usefulness of intraluminal brachytherapy combined with external beam radiation therapy for submucosal esophageal cancer: long-term follow-up results. Int J Radiat Oncol Biol Phys 76:452–459

    Article  PubMed  Google Scholar 

  20. Takahashi H, Arimura Y, Hosokawa M et al (2010) Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 72:255–264

    Article  PubMed  Google Scholar 

  21. Cooper JS, Guo MD, Herskovic A et al (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 281:1623–1627

    Article  PubMed  CAS  Google Scholar 

  22. Al-Sarraf M, Martz K, Herskovic A et al (1997) Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol 15:277–284

    PubMed  CAS  Google Scholar 

  23. Herskovic A, Martz K, al-Sarraf M et al (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326:1593–1598

    Article  PubMed  CAS  Google Scholar 

  24. Yamada K, Murakami M, Okamoto Y et al (2006) Treatment results of chemoradiotherapy for clinical stage I (T1N0M0) esophageal cancer. Int J Radiat Oncol Biol Phys 64:1106–1111

    Article  PubMed  Google Scholar 

  25. Kato H, Sato A, Fukuda H et al (2009) A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group study (JCOG9708). Jpn J Clin Oncol 39:638–643

    Article  PubMed  Google Scholar 

  26. Akagi A, Hirokawa Y, Ito K et al (1999) Optimum fractionation for high-dose-rate endoesophageal brachytherapy following external irradiation of early stage esophageal cancer. Int J Radiat Oncol Biol Phys 43:525–530

    Article  PubMed  CAS  Google Scholar 

  27. Stewart JR, Fajardo LF, Gillette SM et al (1995) Radiation injury to the heart. Int J Radiat Oncol Biol Phys 31:1205–1211

    Article  PubMed  CAS  Google Scholar 

  28. Veinot JP, Edwards WD (1996) Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol 27:766–773

    Article  PubMed  CAS  Google Scholar 

  29. Adams MJ, Hardenbergh PH, Constine LS et al (2003) Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol 45:55–75

    Article  PubMed  Google Scholar 

  30. Ishikura S, Nihei K, Ohtsu A et al (2003) Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol 21:2697–2702

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

No author has any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yuji Murakami, Yasushi Nagata, Ikuno Nishibuchi, Tomoki Kimura, Masahiro Kenjo & Yuko Kaneyasu

  2. Department of Radiology, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan

    Tomoyuki Okabe

  3. Department of Radiology, Chugoku Rosai General Hospital, 1-5-1 Tagaya, Kure, Hiroshima, 737-0193, Japan

    Yasutoshi Hashimoto

  4. Hiroshima Heiwa Clinic, 1-21 Kawaramachi, Naka-ku, Hiroshima, 730-0856, Japan

    Yukio Akagi

Authors
  1. Yuji Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasushi Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ikuno Nishibuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomoki Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Kenjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuko Kaneyasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomoyuki Okabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasutoshi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yukio Akagi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuji Murakami.

About this article

Cite this article

Murakami, Y., Nagata, Y., Nishibuchi, I. et al. Long-term outcomes of intraluminal brachytherapy in combination with external beam radiotherapy for superficial esophageal cancer. Int J Clin Oncol 17, 263–271 (2012). https://doi.org/10.1007/s10147-011-0285-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-011-0285-4

Keywords

Search

Navigation