INTRALUMINAL BRACHYTHERAPY IN ESOPHAGEAL CANCERDr Saeed Karimkhani Radiation oncologist

183/1 24 3/1 32 3/1 40 SCC Adenocarcinoma Tis insitustage oTisT1 I stageT1T2 stage IIAT3-T2T3 stage IIBT1,2 ,N1T4 Stage IIIT3,N1 or T4stage IVAM1astage IVBM1b

34

survival stage

Local recurrence after chemoradiation in SCC & adeno

. RTOG 92-07 1999 49 patients stage II,III Chemoradiation as protocol RTOG 8501 -HDR ILBT(0.2 0.5 Gy/min) applicator external diameter (4-6 mm) -fraction of 5 Gy/w during weeks 8, 9, and 10 (39) At 1 cm from middwell position with equal dwell times The cumulative incidence of fistula 18%/year fistula =12% --- 6(3 fetal) 5 of 6 ,TL=3 - 5.5cm 5 of 6 ,1/3upper 5 of 6 ,TD=15Gy/3f Stricture 4%

15Mean length 6 cm (1.5-10)

Local failure as the only site of failure 29% Survival 1y ,2y, 3y 49%,31%,29%Local ,regional recurrence ,metastases = RTOG 8501

RTOG 8501Survival 5y 27% median 14 monthThe incidence of local failure as the first site of failure 45% Masanori Japan 2001External irradiation (ERT) in 100 pts 4065 Gy, fractions: 2.2 (2.02.5) without concurrent chemotherapyILBT -LDR Total dose 16.4 Gy(1024.3) in 2-3f each fraction 7.1 Gy(6.58.0) applicator diameter 1 cm , reference point at the mucosal surface of the esophagusOverall treatment time (days) 69.9 (4492)17Total dose (ERT+ILBT) 73.5 (6097.6)23%tumor confined to sub mucosal muscle (superficial)80% 1/3 lower,1/3 middle 2y ,5y OS : 45.8% , 12.6% for tumor5 cm: 59.5% , 22.6%for superficial type : 76.6% , 20.4% 2y, 5y local recurrence-free survival rates : 52.5% , 33.9% 13 surviving patients, 8 disease free , 5 alive with disease 87 died, 51 of locoregional recurrence 12 of distant metastases 22 patients of other diseases CR rate tumors 5 cm 78.3% (36/46) tumors >5 cm was 59.3% (32/54)local control rate 2y tumors of 5 cm with > 20 Gy ILBT: 83% (5:6) with 74 GYRohini244/4HDRa three-fold increase of late toxicity No diff OS 5yMultivariate Analysis of Treatment Outcome in Patients With Esophageal Carcinoma Treated With Definitive Radiotherapy. Article American Journal of Clinical Oncology. 26(4):392-397, August 2003.Kodaira, Takeshi M.D.; Fuwa, Nobukazu M.D.; Itoh, Yoshiyuki M.D.; Kamata, Minoru M.D.; Furutani, Kazuhisa M.D.; Hatooka, Syunzo M.D.; Shinoda, Masayuki M.D. Abstract: To evaluate patient characteristics and treatment factors influencing outcome of patients treated with definitive radiotherapy, we performed retrospective analysis. From 1983 to 2000, 154 patients who were diagnosed as esophageal carcinoma without distant metastasis received definitive radiotherapy with (N = 90) or without (N = 64) systemic chemotherapy. One hundred forty-two males and 12 females were entered in the analysis. Thirty-four patients received an additional boost of intracavitary brachytherapy (ICBT). The median patient age was 68 years (range: 46-86). Disease stage was distributed as stage I, II, III, and IV for 33, 42, 33, and 45 patients, respectively. External beam radiotherapy was prescribed with a median 63 Gy (range: 38-77.8 Gy). The 2- and 5-year overall survival (OAS) and local control (LC) rates were 40.8/18.4% and 48.6/28.9%, respectively. In uni-/multivariate analyses, significant prognostic factors of OAS proved to be advanced T stage, absence of ICBT, and age less than 65 years. As for LC, adverse prognostic factors of uni/multivariate analysis were advanced T stage and poor performance status. The pretreatment T stage showed the most powerful influence on both survival and LC. Combination use of ICBT is proven to refine treatment outcome, although eligible criteria should be decided by a prospective study. 1- 2- 90 % 3- CR 4- survival (