- Email: [email protected]
Retrospective Review of the Dosimetric and Treatment-Related Determinants of Toxicity in Patients with Esophageal Cancer Treated with Concurrent Chemoradiation with or without Surgery
Proceedings of the 53rd Annual ASTRO Meeting died of intercurrent diseases without evidence of recurrence. In addition, another patient died of treatment related death because of esophageal fistula. The 5-year cause-specific survival (CSS) and the loco-regional control (LRC) rates were 84% and 73%, respectively. The use of HDR-IB tended towards statistical significance for CSS (p = 0.07), if compared with 19 patients who received EBRT alone during the period of this study (59%). For cardio-pulmonary adverse effects, Grade 1 and Grade 2 toxicities were observed in 3 and 2 patients, respectively, but no Grade 3 or severe toxicities developed. Conclusions: Radiation therapy alone using HDR-IB is very effective and tolerable for Stage I thoracic esophageal cancer, even in patients with SMC. Severe cardio-pulmonary adverse events in this study were much less than those reported by recent studies using concurrent chemoradiotherapy Author Disclosure: H. Ishikawa: None. S. Noda: None. T. Tamaki: None. T. Nonaka: None. T. Ebara: None. H. Katoh: None. T. Kaminuma: None. T. Sato: None. T. Takahashi: None. T. Nakano: None.
2227
Does 3-D CRT Plan Become a Clinical Relevant Factor to Radiation Pneumonitis Risk in Patients with Esophageal Cancer Treated with Definitive Chemoradiotherapy?
M. Myojin1, S. Tanabe1, M. Hosokawa1, S. Shimizu2 1 Keiyukai Sapporo Hospital, Sapporo 003-27, Japan, 2Hokkiado University School of Medicine, Sapporo, Japan Purpose/Objective(s): For definitive chemoradiotherapy (CRT) in patients (pts.) with SCC of the thoracic esophagus, it is believed in Japan that all of the three-field (neck, thorax and abdomen) lymphatics should be evenly included in the CTV because of the advanced surgical data on three-field lymph node dissection. To reduce radiation pneumonitis (RP) risk, we evaluated onearm cohort for the 3-D CRT plan, which was developed for the reduction of peripheral lung dose, by a review of the consecutive series including historical control pts. with conventional treatment plan. Materials/Methods: We retrospectively reviewed the records of 260 consecutive patients who were treated with definitive CRT (50.4Gy/28F 3-regional RT+ 2 cycles of FP +/- 9Gy/5F boost RT) between Sep. 2004 and Oct. 2010. After we ruled out those who had passed away from cancer without RP within less than 4 months from the beginning, 244 (Age 37-80, median 66.5) out of the 260 records were available for this study. RP were defined as ARDS and pneumonitis in CTCAE ver. 4. Every grade 2-5 RP has been observed from 1.6 to 5 months from the beginning in this series. From June 2009, eighty-four pts. of the 244 were enrolled to a cohort for the treatment plan in 3-D CRT different from conventional method for the 50.4Gy to the CTV covering the three-field lymphatics. The new treatment plan consisted of basic AP-PA and supporting two oblique beams separated vertically at the spinal curvature (weight; upper 10-12% and lower 20-22%). Those plans were characterized that V5 and V10 were significantly lower than the conventional plans (AP-PA , and RAO-LPO after 40Gy) in our other presentation. To clarify the clinical relevant factors to improve RP risk, Fisher’s exact method and logistic regression analysis were available for statistics. Results: We had experienced 9 RP(Grade 5: 2, Grade 4: 2, Grade 3: 3, and Grade 2: 2) cases in this study . There was no RP in the cohort group. Statistical analyses between onset of RP and each of several independent factors; age ($71 vs. #70; n 75:169), COPD/ respiratory disorder (+ vs. -; n 17:227), gender (M vs. F; n 220:24), RT dosage (50.4Gy vs. 59.4Gy; n 52:192), chemo. cycles (2 vs.1; n 210:34), main tumor location (mid-thoracic vs. other thoracic) and 3D CRT plan (cohort vs. conventional; n 84:160) resulted that age and 3D CRT plan are significant factors to RP risk (age; p = 0.013 and 3D CRT plan; p = 0.032 in a logistic regression analysis). Conclusions: The causal relationship between RP and RT dose distribution was confirmed in the practice under the environment of intensive CRT. Author Disclosure: M. Myojin: None. S. Tanabe: None. M. Hosokawa: None. S. Shimizu: None.
2228
Retrospective Review of the Dosimetric and Treatment-Related Determinants of Toxicity in Patients with Esophageal Cancer Treated with Concurrent Chemoradiation with or without Surgery
R. Shiloh1, S. S. Rakhra1, J. Evans2, I. Helenowski2, Z. Kang1, M. F. Mulcahy1, W. Small1, J. P. Hayes1 1
Northwestern Memorial Hospital, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Chicago, IL
Purpose/Objective(s): To investigate the dosimetric determinants and the effects of different radiotherapy techniques on acute and late pulmonary and cardiac toxicity in patients with esophageal cancer. Materials/Methods: Between January 2003 and November 2010, 71 patients treated at our institution met criteria of our IRBapproved protocol. Eligibility included patients of all ages with esophageal cancer of any stage or histology treated with definitive multimodality therapy that included radiotherapy. Data collected for each patient included cancer stage and histology, chemotherapy regimen, RT technique, surgical status, dose-volume histograms, acute and late toxicity based on CTCAE 4.0 criteria, and survival. DVH values were calculated with and without heterogeneity correction. Results: The median mean lung dose (heterogeneity corrected) was 1315 cGy for AP/PA with off-cord boost and 1227 cGy for multi-field conformal (MFC) radiation therapy (p = 0.44). The median lung V20 (heterogeneity corrected) was 20.4% for AP/PA/ off-cord boost and 21.7% for MFC (p = 0.85). The median mean heart dose (heterogeneity corrected) was 3593 cGy for AP/PA/ off-cord boost and 3398 cGy for MFC (p = 0.08). Only Heart V30 (AP/PA/off-cord boost 72.5% vs. MFC 58.0%, P = 0.02) and V40 (AP/PA/off-cord boost 51.0% vs. MFC 34.7%, p = 0.04) had statistically significant differences between the two techniques. There was no significant difference when DVH parameters were calculated with heterogeneity correction. There was 1 case of grade 3/4 acute lung toxicity (1.4%), 5 cases of grade 3/4 late lung toxicity (7.0%), 1 case of grade 3/4 acute cardiac toxicity (1.4%), and 4 cases of grade 3/4 late cardiac toxicity (5.6%). No DVH parameter was significantly associated with increased risk of any toxicity. Twenty two patients (31.0%) had surgery after chemoradiation. Those patients who had surgery had a higher rate of late grade 3/4 cardiac toxicity than those who did not have surgery (18.2% vs. 0%, p = 0.008). No cardiac DVH parameters were significantly associated with toxicity in the subset of patients who ultimately underwent surgery. Overall survival at 3 years was 57.0% for Stage I/II, 40.5% for Stage III, and 10.2% for Stage IV (p = 0.045). There was no significant difference in survival based on histology.
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I. J. Radiation Oncology d Biology d Physics
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Volume 81, Number 2, Supplement, 2011
Conclusions: In patients receiving chemoradiation for esophageal cancer at our institution, there was no significant correlation between the DVH parameters attained with MFC or AP/PA/off-cord boost techniques and the risk of acute or late pulmonary or cardiac toxicity. Patients may be safely treated with chemoradiation using either MFC or AP/PA with off-cord boost techniques without a significantly increased risk of toxicity. Author Disclosure: R. Shiloh: None. S.S. Rakhra: None. J. Evans: None. I. Helenowski: None. Z. Kang: None. M.F. Mulcahy: None. W. Small: None. J.P. Hayes: None.
2229
Patterns of Practice, Outcomes and Selection of Treatment Modalities for Patients with Localized Esophageal (E) and Gastroesophageal (GE) Cancer
S. Kang1, E. G. Atenafu2, J. Kim1, J. Brierley1, R. Dinniwell1, B. Cummings1, J. Knox3, L. Geoffrey3, G. Darling4, K. S. R. Wong1 1 Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada, 3Department of Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada, 4Division of Thoracic Surgery, Department of Surgical Oncology, Princess Margaret and Toronto General Hospitals, Toronto, ON, Canada
Purpose/Objective(s): The treatment paradigm of resectable E and GE tumors has shifted from single modality to multimodality therapy based on positive data from systematic reviews and randomized trials. A uniform treatment philosophy was used by our group since the adoption of these multimodality approaches in 2002 reinforced through internal treatment policies, tumor board and quality assurance rounds. The changes in pattern of practice in the last 11 years at a single tertiary referral centre were reviewed. The impact on patient outcomes and selection of the different treatment modalities were analyzed. Materials/Methods: A retrospective database was created combining data from the institution’s cancer registry, esophageal cancer surgical database and radiotherapy treatment records. All patients with a diagnosis of E and GE cancers registered at our institution between 1998 and 2009 were included. Outcomes of patients with Stage (S) I-III and unknown stage (U) (typically due to surgery performed at an external institution) were examined. Standard staging workup was endoscopy and body CT during the period of this review. Results: A total of 1419 pts were included - 897 had SI-III or U (84 SI, 409 SII, 359 SIII and 45 U) and 631 (70%) pts were treated with a curative intent. Of these, 260 were treated with surgery alone (Sx), 136 CRTS, 127 CRT, 51 radiotherapy alone (RT), and 57 Sx+miscellaneous adjuvant treatments (Sx+other). A palliative approach (P) was recommended for 266 (30%) patients. The overall survival (OS) at 2 yr were 63% Sx, 62% CRTS, 60% Sx+other, 39% RT, 38% CRT and 12% P. At 5 yr, our OS were 43% Sx, 28% CRTS, 28% Sx+other, 20% CRT, 4% RT, and 3% P. The pattern of practice changed significantly overtime. Major changes included the rapid adoption of CRTS rising from 0% (1998) to 19% (2003) and remaining stable thereafter. This was paralleled by a drop of the use of Sx from 53% (1998) to 24% (2003). CRT rose from 10-17% (1998-2007) to 19-22% (2008-9). Patients managed with a non-curative approach dropped steadily from 30% (1998) to 19% by 2009. The survival by year of enrollment improved overtime (5 yr OS 9% in 1998 and 18-30% from 2003-2006). CRTS was more likely to be recommended to younger patients (p\0.0001), more advanced stage (p\0.0001) and adenocarcinomas (p\0.0001). Conclusions: CRTS was recommended to approximately 25% of patients while 20% of patients were treated with CRT. Over the past 11 yrs, we observed a gradual decline in P perhaps reflective of our improved ability to support our patients through optimal therapy. Multimodality treatment may have contributed to the improvement in overall outcome overtime. At this institution, patients who are younger, adenocarcinomas or with more advanced stage cancers are more likely to be managed with CRTS. Author Disclosure: S. Kang: None. E.G. Atenafu: None. J. Kim: None. J. Brierley: None. R. Dinniwell: None. B. Cummings: None. J. Knox: C. Other Research Support; Pfizer, Bayer, Novartis. L. Geoffrey: None. G. Darling: None. K.S.R. Wong: None.
2230
Radical Radiotherapy for Superficial Esophageal Squamous Cell Carcinoma: Impact of Clinical N Stage on Survival
T. Ariga1, K. Ogawa1, H. Shimoji2, H. Karimata2, T. Toita1, Y. Kakinohana1, G. Kasuya1, N. Yoshimi3, T. Nishimaki2, S. Murayama1, S. Murayama1 1
Dept. of Radiology, Okinawa, Japan, 2Dept. of Surgery, Okinawa, Japan, 3Dept. of Pathology, Okinawa, Japan
Purpose/Objective(s): To retrospectively analyze the results of radical radiotherapy for patients with superficial esophageal squamous cell carcinoma. Materials/Methods: Forty-eight patients with superficial esophageal squamous cell carcinoma (mucosa: 5 patients, submucosa: 30 patients, undefined: 13 patients) with or without lymph node metastasis treated with radiotherapy were reviewed. The median age of all patients was 72 years (range, 45 to 87 years), and 44 patients were male. The median total dose of external beam radiotherapy (EBRT) was 66Gy (range, 0 to 70 Gy) in conventional fractionations (1.8-2.0 Gy/day) with spinal cord doses of less than 46Gy. 192Iridium Intraluminal brachytherapy (IB) was used in 10 patients, with a single dose of 5-6 Gy at 5 mm applicator distance (total doses of 12-25 Gy in 3-5 fractions). One patient received IB alone as a curative treatment. Concerning EBRT, the site of radiation field was primary site only in 32 patients, and primary site with regional lymph nodes in 16 patients. Fifteen patients (31%) received chemotherapy, and the combination of cisplatin and 5-fluorouracil was frequently used. The median followup of all 48 patients was 28 months (range, 4 to 116 months). Clinical N stage (UICC 2002) was assessed by CT scans, and lymph node short-axis diameter . 10 mm was counted as positive. Overall survival (OS), disease-free survival (DFS) and local control (LC) rates were calculated actuarially according to the Kaplan-Meier method, and were measured from the first day of radiotherapy. Differences between the groups were estimated using generalized Wilcoxon tests. P \0.05 was considered to be statistically significant. Results: At the time of this analysis, 11 patients (23%) had in-field local recurrence, 3 patients had regional lymph node recurrence outside of the irradiated field, and 2 patients had distant metastasis. The 5-year LC rate of all 48 patients was 74.2%.
2227
Does 3-D CRT Plan Become a Clinical Relevant Factor to Radiation Pneumonitis Risk in Patients with Esophageal Cancer Treated with Definitive Chemoradiotherapy?
M. Myojin1, S. Tanabe1, M. Hosokawa1, S. Shimizu2 1 Keiyukai Sapporo Hospital, Sapporo 003-27, Japan, 2Hokkiado University School of Medicine, Sapporo, Japan Purpose/Objective(s): For definitive chemoradiotherapy (CRT) in patients (pts.) with SCC of the thoracic esophagus, it is believed in Japan that all of the three-field (neck, thorax and abdomen) lymphatics should be evenly included in the CTV because of the advanced surgical data on three-field lymph node dissection. To reduce radiation pneumonitis (RP) risk, we evaluated onearm cohort for the 3-D CRT plan, which was developed for the reduction of peripheral lung dose, by a review of the consecutive series including historical control pts. with conventional treatment plan. Materials/Methods: We retrospectively reviewed the records of 260 consecutive patients who were treated with definitive CRT (50.4Gy/28F 3-regional RT+ 2 cycles of FP +/- 9Gy/5F boost RT) between Sep. 2004 and Oct. 2010. After we ruled out those who had passed away from cancer without RP within less than 4 months from the beginning, 244 (Age 37-80, median 66.5) out of the 260 records were available for this study. RP were defined as ARDS and pneumonitis in CTCAE ver. 4. Every grade 2-5 RP has been observed from 1.6 to 5 months from the beginning in this series. From June 2009, eighty-four pts. of the 244 were enrolled to a cohort for the treatment plan in 3-D CRT different from conventional method for the 50.4Gy to the CTV covering the three-field lymphatics. The new treatment plan consisted of basic AP-PA and supporting two oblique beams separated vertically at the spinal curvature (weight; upper 10-12% and lower 20-22%). Those plans were characterized that V5 and V10 were significantly lower than the conventional plans (AP-PA , and RAO-LPO after 40Gy) in our other presentation. To clarify the clinical relevant factors to improve RP risk, Fisher’s exact method and logistic regression analysis were available for statistics. Results: We had experienced 9 RP(Grade 5: 2, Grade 4: 2, Grade 3: 3, and Grade 2: 2) cases in this study . There was no RP in the cohort group. Statistical analyses between onset of RP and each of several independent factors; age ($71 vs. #70; n 75:169), COPD/ respiratory disorder (+ vs. -; n 17:227), gender (M vs. F; n 220:24), RT dosage (50.4Gy vs. 59.4Gy; n 52:192), chemo. cycles (2 vs.1; n 210:34), main tumor location (mid-thoracic vs. other thoracic) and 3D CRT plan (cohort vs. conventional; n 84:160) resulted that age and 3D CRT plan are significant factors to RP risk (age; p = 0.013 and 3D CRT plan; p = 0.032 in a logistic regression analysis). Conclusions: The causal relationship between RP and RT dose distribution was confirmed in the practice under the environment of intensive CRT. Author Disclosure: M. Myojin: None. S. Tanabe: None. M. Hosokawa: None. S. Shimizu: None.
2228
Retrospective Review of the Dosimetric and Treatment-Related Determinants of Toxicity in Patients with Esophageal Cancer Treated with Concurrent Chemoradiation with or without Surgery
R. Shiloh1, S. S. Rakhra1, J. Evans2, I. Helenowski2, Z. Kang1, M. F. Mulcahy1, W. Small1, J. P. Hayes1 1
Northwestern Memorial Hospital, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Chicago, IL
Purpose/Objective(s): To investigate the dosimetric determinants and the effects of different radiotherapy techniques on acute and late pulmonary and cardiac toxicity in patients with esophageal cancer. Materials/Methods: Between January 2003 and November 2010, 71 patients treated at our institution met criteria of our IRBapproved protocol. Eligibility included patients of all ages with esophageal cancer of any stage or histology treated with definitive multimodality therapy that included radiotherapy. Data collected for each patient included cancer stage and histology, chemotherapy regimen, RT technique, surgical status, dose-volume histograms, acute and late toxicity based on CTCAE 4.0 criteria, and survival. DVH values were calculated with and without heterogeneity correction. Results: The median mean lung dose (heterogeneity corrected) was 1315 cGy for AP/PA with off-cord boost and 1227 cGy for multi-field conformal (MFC) radiation therapy (p = 0.44). The median lung V20 (heterogeneity corrected) was 20.4% for AP/PA/ off-cord boost and 21.7% for MFC (p = 0.85). The median mean heart dose (heterogeneity corrected) was 3593 cGy for AP/PA/ off-cord boost and 3398 cGy for MFC (p = 0.08). Only Heart V30 (AP/PA/off-cord boost 72.5% vs. MFC 58.0%, P = 0.02) and V40 (AP/PA/off-cord boost 51.0% vs. MFC 34.7%, p = 0.04) had statistically significant differences between the two techniques. There was no significant difference when DVH parameters were calculated with heterogeneity correction. There was 1 case of grade 3/4 acute lung toxicity (1.4%), 5 cases of grade 3/4 late lung toxicity (7.0%), 1 case of grade 3/4 acute cardiac toxicity (1.4%), and 4 cases of grade 3/4 late cardiac toxicity (5.6%). No DVH parameter was significantly associated with increased risk of any toxicity. Twenty two patients (31.0%) had surgery after chemoradiation. Those patients who had surgery had a higher rate of late grade 3/4 cardiac toxicity than those who did not have surgery (18.2% vs. 0%, p = 0.008). No cardiac DVH parameters were significantly associated with toxicity in the subset of patients who ultimately underwent surgery. Overall survival at 3 years was 57.0% for Stage I/II, 40.5% for Stage III, and 10.2% for Stage IV (p = 0.045). There was no significant difference in survival based on histology.
S321
I. J. Radiation Oncology d Biology d Physics
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Volume 81, Number 2, Supplement, 2011
Conclusions: In patients receiving chemoradiation for esophageal cancer at our institution, there was no significant correlation between the DVH parameters attained with MFC or AP/PA/off-cord boost techniques and the risk of acute or late pulmonary or cardiac toxicity. Patients may be safely treated with chemoradiation using either MFC or AP/PA with off-cord boost techniques without a significantly increased risk of toxicity. Author Disclosure: R. Shiloh: None. S.S. Rakhra: None. J. Evans: None. I. Helenowski: None. Z. Kang: None. M.F. Mulcahy: None. W. Small: None. J.P. Hayes: None.
2229
Patterns of Practice, Outcomes and Selection of Treatment Modalities for Patients with Localized Esophageal (E) and Gastroesophageal (GE) Cancer
S. Kang1, E. G. Atenafu2, J. Kim1, J. Brierley1, R. Dinniwell1, B. Cummings1, J. Knox3, L. Geoffrey3, G. Darling4, K. S. R. Wong1 1 Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada, 3Department of Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada, 4Division of Thoracic Surgery, Department of Surgical Oncology, Princess Margaret and Toronto General Hospitals, Toronto, ON, Canada
Purpose/Objective(s): The treatment paradigm of resectable E and GE tumors has shifted from single modality to multimodality therapy based on positive data from systematic reviews and randomized trials. A uniform treatment philosophy was used by our group since the adoption of these multimodality approaches in 2002 reinforced through internal treatment policies, tumor board and quality assurance rounds. The changes in pattern of practice in the last 11 years at a single tertiary referral centre were reviewed. The impact on patient outcomes and selection of the different treatment modalities were analyzed. Materials/Methods: A retrospective database was created combining data from the institution’s cancer registry, esophageal cancer surgical database and radiotherapy treatment records. All patients with a diagnosis of E and GE cancers registered at our institution between 1998 and 2009 were included. Outcomes of patients with Stage (S) I-III and unknown stage (U) (typically due to surgery performed at an external institution) were examined. Standard staging workup was endoscopy and body CT during the period of this review. Results: A total of 1419 pts were included - 897 had SI-III or U (84 SI, 409 SII, 359 SIII and 45 U) and 631 (70%) pts were treated with a curative intent. Of these, 260 were treated with surgery alone (Sx), 136 CRTS, 127 CRT, 51 radiotherapy alone (RT), and 57 Sx+miscellaneous adjuvant treatments (Sx+other). A palliative approach (P) was recommended for 266 (30%) patients. The overall survival (OS) at 2 yr were 63% Sx, 62% CRTS, 60% Sx+other, 39% RT, 38% CRT and 12% P. At 5 yr, our OS were 43% Sx, 28% CRTS, 28% Sx+other, 20% CRT, 4% RT, and 3% P. The pattern of practice changed significantly overtime. Major changes included the rapid adoption of CRTS rising from 0% (1998) to 19% (2003) and remaining stable thereafter. This was paralleled by a drop of the use of Sx from 53% (1998) to 24% (2003). CRT rose from 10-17% (1998-2007) to 19-22% (2008-9). Patients managed with a non-curative approach dropped steadily from 30% (1998) to 19% by 2009. The survival by year of enrollment improved overtime (5 yr OS 9% in 1998 and 18-30% from 2003-2006). CRTS was more likely to be recommended to younger patients (p\0.0001), more advanced stage (p\0.0001) and adenocarcinomas (p\0.0001). Conclusions: CRTS was recommended to approximately 25% of patients while 20% of patients were treated with CRT. Over the past 11 yrs, we observed a gradual decline in P perhaps reflective of our improved ability to support our patients through optimal therapy. Multimodality treatment may have contributed to the improvement in overall outcome overtime. At this institution, patients who are younger, adenocarcinomas or with more advanced stage cancers are more likely to be managed with CRTS. Author Disclosure: S. Kang: None. E.G. Atenafu: None. J. Kim: None. J. Brierley: None. R. Dinniwell: None. B. Cummings: None. J. Knox: C. Other Research Support; Pfizer, Bayer, Novartis. L. Geoffrey: None. G. Darling: None. K.S.R. Wong: None.
2230
Radical Radiotherapy for Superficial Esophageal Squamous Cell Carcinoma: Impact of Clinical N Stage on Survival
T. Ariga1, K. Ogawa1, H. Shimoji2, H. Karimata2, T. Toita1, Y. Kakinohana1, G. Kasuya1, N. Yoshimi3, T. Nishimaki2, S. Murayama1, S. Murayama1 1
Dept. of Radiology, Okinawa, Japan, 2Dept. of Surgery, Okinawa, Japan, 3Dept. of Pathology, Okinawa, Japan
Purpose/Objective(s): To retrospectively analyze the results of radical radiotherapy for patients with superficial esophageal squamous cell carcinoma. Materials/Methods: Forty-eight patients with superficial esophageal squamous cell carcinoma (mucosa: 5 patients, submucosa: 30 patients, undefined: 13 patients) with or without lymph node metastasis treated with radiotherapy were reviewed. The median age of all patients was 72 years (range, 45 to 87 years), and 44 patients were male. The median total dose of external beam radiotherapy (EBRT) was 66Gy (range, 0 to 70 Gy) in conventional fractionations (1.8-2.0 Gy/day) with spinal cord doses of less than 46Gy. 192Iridium Intraluminal brachytherapy (IB) was used in 10 patients, with a single dose of 5-6 Gy at 5 mm applicator distance (total doses of 12-25 Gy in 3-5 fractions). One patient received IB alone as a curative treatment. Concerning EBRT, the site of radiation field was primary site only in 32 patients, and primary site with regional lymph nodes in 16 patients. Fifteen patients (31%) received chemotherapy, and the combination of cisplatin and 5-fluorouracil was frequently used. The median followup of all 48 patients was 28 months (range, 4 to 116 months). Clinical N stage (UICC 2002) was assessed by CT scans, and lymph node short-axis diameter . 10 mm was counted as positive. Overall survival (OS), disease-free survival (DFS) and local control (LC) rates were calculated actuarially according to the Kaplan-Meier method, and were measured from the first day of radiotherapy. Differences between the groups were estimated using generalized Wilcoxon tests. P \0.05 was considered to be statistically significant. Results: At the time of this analysis, 11 patients (23%) had in-field local recurrence, 3 patients had regional lymph node recurrence outside of the irradiated field, and 2 patients had distant metastasis. The 5-year LC rate of all 48 patients was 74.2%.