The role of high-dose-rate brachytherapy (HDR-BT) in the radiotherapy of esophageal carcinoma

Abstract

Objective:To study the role of high-dose-rate brachytherapy (HDR-BT) in the radiotherapy of esophageal cancer.Methods:We reviewed 89 patients with esophageal carcinoma treated with radiation therapy between March 1999 and December 2005 in our hospital.There were 62 patients in the external beam radiotherapy group (EBRT group) and 27 patients in the combination of HDR-BT and EBRT group (combined group).Forty-two patients received sequential or concurrent chemotherapy.Patients in EBRT group were firstly treated with parallel-opposed antero-posterior field at a total dose of 40Gy,and then off-cord oblique fields were used at a final median total dose of 65Gy (ranged from 40 to 70Gy). HDR-BT was commonly performed weekly for 2-3 times at a dose fraction of 4-7Gy.Some patients received sequential or concurrent chemotherapy with cisplatin and fluorouracil.The endpoints were complete release (CR),improvement of obstruction, local-recurrence free survival (LRFS) and overall survival (OS).Chi-square test was used for comparison of the difference in CR rate and the improvement in patients' food intaking.Kaplan-Meier method was exployed to analyze patient survival and Log-rank test was used to compare the difference in OS and LRFS.Results:The median follow-up period was 34 months.Sixty-three patients died during the follow up.The CR rates of EBRT group and combined group were 10% and 29%,respectively (P=0.049).The improvement rate in food intaking in the two groups were 67.7% and 74.1%,respectively (P=0.795).The 5-year LRFS was 24% in EBRT group and 36% in combined group (P=0.332).The 5-year OS was 18% in EBRT group and 21% in combined group (P=0.401).The 5-year OS was 42% in patients with tumor smaller than 5cm and 36% in patients with tumor larger than 5cm (P=0.045).The 5-year OS was 16% in patients treated with brachytherapy and 14% in patients who didn't receive brachytherapy (P=0.685).Conclusion:The combination of HDR-BT and EBRT can improve the response rate and the long term survival of patients with small esohpageal carcinoma.