2078 Radiotherapy for superficial esophageal cancer of poor risk patients

Proceedings of the 39th Annual ASTRO Meeting

279

2077 OPTIMUM

FRACTIONATION

IRRADIATION

Y. Akagi,’

FOR HIGH

OF SUPERFICIAL

Y. Hirokawa,r

DOSE

of Radiology,

Hlroshhna

Unversity

Qepartment

of Radiology,

Hiroshima

City Hospital,

Materials

and

mediastin~ Hiroshhna and spinal

School

2A.Ito,tK.

Fujita,rK.

Matsuura,*M.Kenjo,rH.

of Medicine,

Hiroshima,

Japan

Hiroshima,

FOLLOWING

EXTERNAL

Khiu,rK.Itor

Japan

To establish an optimum fractionation data of patients treated with different HDR Methods: The study population consists

from retrcspectivc

BRACHYTHERAPY

CANCER

T. Kawakami,

M. Kagemoto,z

IDepartment

Objective/Purpose:

RATE INTRALUMINAL

ESOPHAGEAL

for high dose rate (HDR) intraluminal schedules following external Irradiation. of consecutive superficial esophageal

brachytherapy

for superficial

cancer

who

patients

esophageal

received

cancer

external

beam

Irradiation plus tit11 dose intraluminal brachytherapy from May 1992 to November 1995 in Hiroshima University Medical Center and City Hospital. lbere were 35 eligible cases. All patients were treated with external beam irradiation to doses ranging from 50 to 61 Gy, cord was spared after 44 to 45 Gy. HDR intraluminal brachytherapy boost with double balloon applicator was used by [r-192(10 Ci to

4.3 Ci) remote afterloading systemsone group of 10 patients was treated with 2 or 3 lntrahrminal boosts given a week apart with a dose of 4 or 5 Gy at a distance of 5 mm from the applicator surface, and another group of 25 patients was treated 4 or 5 intraluminal boosts given in a week with a dose of 2 or 2.5 Gy. The linear quadratic (IQ) formula was used to calculate the biologically effective dose (BED) to tumor( Gyro) and esophageal mucosa(

Gys).

Kaplan-Meyer

method

was used to calculated

was used to study for significance. Results: Six (17%) of the 35 patients

for local control

rates and late complication

occurrence

rates and generalized

Wilcoxon

method

recurred

and 7 (20%)

correlate with local control and late complications. tumor control may be compromised with a tumor 2.0 Gy at a distance below 142 Gys and

had late complication

(esophageal

ulcer

> Grade

l).The

M

formula

appears

A BED above 142 Gys was associated with Grade 2+3(RTOG) esophageal ulcers. BED above 96 Gyto. A BED analysis showed that the fraction size should be decreased

of 5 mm from the applicator surface a BED above 96 Gyro give approval.

and the fraction

number

should

be increased

to 4 or 5 times, respectively

, to let a BED

A larger reduction of brachytherapy dose is necessary for reduction of late complications. Our most recently developed esophageal cancer patients is 5 time applications on a week with 2 Gy at a distance of 5 mm from the applicator surface

Conclusion:

superficial external

irradiation

schedule following

for an

of 60 Gy

2078 RADIOTHERAPY

FOR SUPERFICIAL

Yoshikazu

Kagami.

Hiroshi

Tokuue,

Minako

Sumi, Mitsuhiko

National

Cancer

Center

Puroose/Obie&

has been

esophagectomy

with 3 fields

of some reasons, radiotherapy

patients

PATIENTS Yuji Tachimori,

Hoichi

Kato.

Hiroshi

Watanabe,

Kouichi

Imai and Shuji Nakayama

SEC

esophageal

treatment

cancer(SEC)

has steadily

of SEC is endoscopical

for submucosal

cancer.

by radiotherapy

Radiotherapy

alternative

increased

mucosal is little

to surgery.

in Japan

resection place

Purpose

as result

(EMR)

of endoscopic

for mucosal

for the management

of this report

cancer

of SEC.

is to evaluate

or

Because

efficacy

of

Reasons

of

for SEC.

Methods

& Materials:

radiotherapy

Between

that waschosen

and double

primary

endoscopy

and radiography.

and I6 patients carcinoma.

cancer

(88.9%)

1989

to 1996,

as the primary in I3 patients

(head

had tumor

invaded

There were 17 male patients

patients

was TINOMO

did both Ex and intracavitary

follow-up

according

was 6 months

Results:

The overall

esophageal

cancer.

and/or

Three

distant

conservative

treatment

Conclusions:

Local

organs.

and neck:

11. simultaneously: with endoscopic

staging

radiotherapy

than esophageal (16.7%)

SEC were

treated

of surgery

with

11). No patients ultrasound.

of these tumors

radiotherapy

in one patient, had indication

Two patients (38.9%)

at our hospital.

poor medical

underwent

external

condition

of EMR.

were multicentric.

All

radiotherapy

(Ex)

Gy of Ex with 5-15 Gy of IC). No patients

received

in 4 patients

Diagnosis

(I I. 1%) had tumor

limited

patients

The age range was 49 years to 87 years with a median

system. Ten patients

with a median

In 2 patients

Seven

patient.

(IC) (30-60

was made by to the mucosa

had squamous

of 62 years.

(50 Gy

cell

Stage of all

66 Gy) alone

chemotherapy.

and 8

Duration

of

of 30 months.

rate was 55.9 % in 3-year patients

with

were rufusal

were examined the submucosa.

to UICC

tumor other

patients

of treatment

and one female

to 96 months

survival

were malignant

eighteen

methods

Some patients

patients

nodes

resection

with

RISK

Yamaguchi.

Japan)

In Japan,

nodes

OF POOR

Hajime

Atsushi

of superficial

common.

lymph

we treated

(Tokyo,

incidence

become

CANCER

Murayama,

Kawashima.

Hospital

The reported

examination

death

ESOPHAGEAL

Ikeda, Shigeyuki

and 14 % in Syear,

cancer

recurred

disease

( 1 I. 1%). esophageal

in 4 patients, in esophagus ulcer

and the cause-specific

intercurrent within

had developed

disease

5year

other

or out of radiation but cured

survival

than malignant fields.

rate was 100 %. Causes tumor

No recurrences

in 3 patients occurred

of

and no in lymph

by

with medication. control

be an alternative

to surgery

with or without

chemotherapy),

and cause-specific in patients

survival

rates were excellent

with SEC. We should

treatment

field,

optimal

do further

administrated

in patients

researches

who had undergone

concerning

dose and so on.

treatment

radiotherapy. method

(Ex alone

to

Adequate to 2.5 or

Radiotherapy

would

or Ex with IC, and