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High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED)

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Abstract

Introduction

Ninety percent of oesophageal cancers are locally advanced at diagnosis, and treatment yields discouraging results. High dose rate brachytherapy (HDR-BT) permits an increment of local doses without a significant increment of toxicity. The goal of our study is to compare different HDR-BT fractions and assess global survival (GS) and cause-specific survival (CSS).

Material and methods

Twenty-six patients were treated for locally advanced oesophageal cancer with chemotherapy concomitant with conformal three-dimensional radiotherapy (C3DR) from January 1994 to December 2000. Of this group, 96.2% were males, mean age 63.08 years; the most frequent location was medium third, for 50% of cases. Eighty-four percent of cases were G2-3 epidermoid carcinomas. The administration consisted of 44.2 Gy with C3DR and 5 applications of HDR-BT of 500 cGy each.

Results

Actuarial GS and CSS at 5 years is 10.18% and 12.96%, a mean survival of 25.68 and 29.14 months respectively. The following factors (C3DR total dose, fraction dose and total dose of HDR-BT, number of applications, active length of application, total dose of C3DR plus HDR-BT, and BED of HDR-BT) are evaluated to find if they have an influence on treatment response, GS and actuarial CSS. The only result that yields statistical significance, in univariant analysis, is the active length in HDR-BT, thus for a greater active length of application, a minor response is obtained and GS diminishes (p=0.05). We grouped BT fractions on biological equivalent dose (BED) into: <28, 28–33 and >33 Gy; mean survival and GS at 5 years increases with BED≥28 Gy (p=0.016).

Conclusion

Tumour response increases (complete and partial) when BED on HDR-BT is increased, regardless of the fraction employed. A BED higher than 28 Gy yields a significant increase of mean survival and GS at 5 years (p=0.016).

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References

  1. Jemal A, Thomas A, Murray T et al (2002) Cancer statistics 2002. CA Cancer J Clin 52:23–47

    Article  PubMed  Google Scholar 

  2. Daly JM, Karnell LH, Menck HR (1996) National cancer data base report on esophageal carcinoma. Cancer 78:1820–1828

    Article  PubMed  CAS  Google Scholar 

  3. Lagergren J, Bergstrom R, Lindgren A et al (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831

    Article  PubMed  CAS  Google Scholar 

  4. Koop H (2002) Gastroesophageal reflux disease and Barrett’s esophagus. Endoscopy 34:97–103

    Article  PubMed  CAS  Google Scholar 

  5. Earlam R, Cunha-Melo JR (1980) Oesophageal squamous cell carcinoma: II. A critical view of radiotherapy. Br J Surg 67:457–461

    Article  PubMed  CAS  Google Scholar 

  6. Muller JM, Erasmo H, Stelzner M et al (1990) Surgical therapy of oesophageal carcinoma. Br J Surg 77:845–857

    Article  PubMed  CAS  Google Scholar 

  7. Roth JA, Putnam JB Jr (1994) Surgery for cancer of the esophagus. Semin Oncol 21:453–461

    PubMed  CAS  Google Scholar 

  8. Wobst A, Audisio RA, Colleoni M et al (1998) Oesophageal cancer treatment: studies, strategies, facts. Ann Oncol 9:931–942

    Article  Google Scholar 

  9. Herskovic A, Marz 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 

  10. Kelsen DP, Ginsberg R, Pajak TF et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

    Article  PubMed  CAS  Google Scholar 

  11. Clark P (2001) Surgical resection with or without pro-operative chemotherapy in oesophageal cancer: an updated analysis of a randomized controlled trial conducted by the UK Medical Research Council Upper GI Tract Cancer Group. Proc Am Soc Clin Oncol 20:126 a (abstract 502)

    Google Scholar 

  12. Urba SG, Orringer MB, Turrisi A et al (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19:305–313

    PubMed  CAS  Google Scholar 

  13. Heath EI, Burtness BA, Heitmiller R et al (2000) Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol 18:868–876

    PubMed  CAS  Google Scholar 

  14. 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). JAMA 281:1623–1627

    Article  PubMed  CAS  Google Scholar 

  15. De-Ren S (1989) Ten years follow-up of esophageal cancer treated by radical radiation therapy: analysis of 869 patients. Int J Radiat Oncol Biol Phys 16:329–334

    Google Scholar 

  16. Maingon P, d’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 

  17. Delcambre C, Jacob JH, Portier D et al (2001) Localized squamous-cell cancer of the esophagus: retrospective analysis of three treatment schedules. Radiother Oncol 59:195–201

    Article  PubMed  CAS  Google Scholar 

  18. Tai P, VanDyk J, Yu E et al (1998) Variability of target volume delineation in cervical esophageal cancer. Int J Radiat Oncol Biol Phys 42:277–288

    Article  PubMed  CAS  Google Scholar 

  19. Yu E, Dar R, Rodrigues GB et al (2004) Is extended volume external beam radiation therapy covering the anastomotic site beneficial in post-esophagectomy high risk patients? Radiother Oncol 73:141–148

    Article  PubMed  Google Scholar 

  20. Kato H, Tachimori Y, Watanabe H et al (1998) Anastomotic recurrence of esophageal squamous cell carcinoma alter trasnthoracic oesophagectomy. Eur J Cancer 164:759–764

    CAS  Google Scholar 

  21. Kyriazanos ID, Tachibana M, Shibakita M et al (2003) Pattern of recurrence after extended esophagectomy for squamous cell carcinoma of the esophagus. Hepatogastroenterology 50:115–120

    PubMed  Google Scholar 

  22. Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: High-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  24. Yorozu A, Dokiya T, Oki Y (1999) High-dose-rate brachytherapy boost following concurrent chemoradiotherapy for esophageal carcinoma. Int J Radiat Oncol Biol Phys 45:271–275

    Article  PubMed  CAS  Google Scholar 

  25. Okawa T (1999) Clinical optimization study of radiotherapy for esophageal cancer. J Jpn Soc Ther Radiol Oncol 11:53–58

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  27. Calais G, Dorsal E, Louisot P et al (1997) Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for stages IIB and III esophageal carcinoma: results of a pilot study. Int J Radiat Oncol Biol Phys 38:769–775

    Article  PubMed  CAS  Google Scholar 

  28. Hujala K, Sipilä J, Minn H et al (2002) Combined external and intraluminal radiotherapy in the treatment of advanced oesophageal cancer. Radiother Oncol 64:41–45

    Article  PubMed  Google Scholar 

  29. Sur RK, Levin CV, Donde B et al (2002) Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma — an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys 53:127–133

    Article  PubMed  Google Scholar 

  30. Hishikawa Y, Kurisu K, Taniguchi M et al (1991) High-dose-rate intraluminal brachytherapy (HDRIBT) for esophageal cancer. Int J Radiat Oncol Biol Phys 21:1133–1135

    PubMed  CAS  Google Scholar 

  31. Datta NR, Kumar S, Nangia S et al (1998) A non-randomized comparison of two radiotherapy protocols in inoperable squamous cell carcinoma of the oesophagus. Clin Oncol 10:306–312

    Article  CAS  Google Scholar 

  32. Gaspar LE, Nag S, Herskovic A et al (1997) American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Clinical Research Committee, American Brachytherapy Society, Philadelphia, PA. Int J Radiat Oncol Biol Phys 38:127–132

    Article  PubMed  CAS  Google Scholar 

  33. Chirat E (2003) La curiethérapie endo-oesophagienne. Cancer Radiother 7:132–135

    PubMed  Google Scholar 

  34. Marinello G, Pierquin B, Grimard L et al (1992) Dosimetry of intraluminal brachytherapy. Radiother Oncol 23:213–216

    Article  PubMed  CAS  Google Scholar 

  35. Geh JI, Bond SJ, Bentzen SM et al (2006) Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol 78:236–244

    Article  PubMed  CAS  Google Scholar 

  36. Suntharalingam M (2006) Definitive chemoradiation in the management of locally advanced esophageal cancer. Semin Radiat Oncol 17:22–28

    Article  Google Scholar 

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Authors and Affiliations

  1. Oncologic Radiotherapy Service Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército, s/n, ES-28047, Madrid, Spain

    M. C. López Carrizosa, P. M. Samper Ots, A. Rodríguez Pérez, A. Sotoca, J. Sáez Garrido & M. M. de Miguel

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  1. M. C. López Carrizosa
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  2. P. M. Samper Ots
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  3. A. Rodríguez Pérez
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  4. A. Sotoca
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  5. J. Sáez Garrido
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  6. M. M. de Miguel
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Correspondence to M. C. López Carrizosa.

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López Carrizosa, M.C., Samper Ots, P.M., Rodríguez Pérez, A. et al. High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED). Clin Transl Oncol 9, 385–391 (2007). https://doi.org/10.1007/s12094-007-0071-y

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  • DOI: https://doi.org/10.1007/s12094-007-0071-y

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