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Purpose: To reveal early intervention outcomes for patients describing with choroidal metastasis. Methods: A retrospective interventional case series on 27 eyes of 22 patients treated for choroidal metastasis with external beam radiation therapy (EBRT) With and without intravitreal injections. The prescribed radiation dose was a mean and median 30 Gy (range of 30–40 Gy in 180–200 cGy daily fractions). Outcome measures included change in tumor thickness, subretinal fluid, visual acuity, radiation oculopathy, and survival. Results: Decreased vision was the most common presenting symptom (n = 20/27, 74%). Pre?treatment vision for subfoveal lesions was a mean 20/400, median 20/200, and range 20/40 to hand motions (HM). Pre?treatment vision for extrafoveal tumors were a mean 20/40, median 20/25, range 20/20 to counting fingers (CF) which improved to a mean 20/32, median 20/20, range 20/12.5 to 20/200. Local control, with ultrasonographic height regression (44.5%; mean: 2.7–1.5 mm), was observed in all eyes at mean follow?up of 16 months (range: 1–72 months). Intravitreal anti?vascular endothelial growth factor (anti?VEGF) was given in nine cases (n = 9/27, 33%) to slow the growth of the metastasis and suppress their exudative detachments and to treat radiation maculopathy in 10 cases (n = 10/27, 37%). Late radiation complications included keratoconjunctivitis sicca in four cases (n = 4/27, 15%), exposure keratopathy in two cases (n = 2/27, 7%), and radiation retinopathy in 10 cases (n = 10/27, 37%). Of the 23 phakic eyes, four (n = 4, 17%) developed cataract. Conclusion: Radiation therapy with or without intravitreal anti?VEGF injections was a safe and effective treatment for choroidal metastasis. It was associated with local tumor control, reduction of secondary retinal detachments, and vision preservation.
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OBJECTIVE@#To identify the problems in clinical radiotherapy planning for cervical cancer through quantitative evaluation of the radiotherapy plans to improve the quality of the plans and the radiotherapy process.@*METHODS@#We selected the clinically approved and administered radiotherapy plans for 227 cervical cancer patients undergoing external radiotherapy at Sun Yat-sen University Cancer Center from May, 2019 to January, 2022. These plans were transferred from the treatment planning system to the Plan IQTM workstation. The plan quality metrics were determined based on the guidelines of ICRU83 report, the GEC-ESTRO Working Group, and the clinical requirements of our center and were approved by a senior clinician. The problems in the radiotherapy plans were summarized and documented, and those with low scores were re-planned and the differences were analyzed.@*RESULTS@#We identified several problems in the 277 plans by quantitative evaluation. Inappropriate target volume selection (with scores < 60) in terms of GTV, PGTV (CI) and PGTV (V66 Gy) was found in 10.6%, 65.2%, and 1% of the plans, respectively; and the PGTV (CI), GTV, and PCTV (D98%, HI) had a score of 0 in 0.4%, 10.1%, 0.4%, 0.4% of the plans, respectively. The problems in the organs at risk (OARs) involved mainly the intestines (the rectum, small intestine, and colon), found in 20.7% of the plans, and in occasional cases, the rectum, small intestine, colon, kidney, and the femoral head had a score of 0. Senior planners showed significantly better performance than junior planners in PGTV (V60 Gy, D98%), PCTV (CI), and CTV (D98%) (P≤0.046) especially in terms of spinal cord and small intestine protection (P≤0.034). The bowel (the rectum, small intestine and colon) dose was significantly lower in the prone plans than supine plans (P < 0.05), and targets coverage all met clinical requirements. Twenty radiotherapy plans with low scores were selected for re-planning. The re-planned plans had significantly higher GTV (Dmin) and PTV (V45 Gy, D98%) (P < 0.05) with significantly reduced doses of the small intestines (V40 Gy vs V30 Gy), the colon (V40 Gy vs V30 Gy), and the bladder (D35%) (P < 0.05).@*CONCLUSION@#Quantitative evaluation of the radiotherapy plans can not only improve the quality of radiotherapy plan, but also facilitate risk management of the radiotherapy process.
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Humans , Female , Uterine Cervical Neoplasms/radiotherapy , Rectum , Colon , Kidney , Organs at RiskABSTRACT
Objective: Cervical carcinoma is one of the leading causes of cancer-related deaths. This study evaluates improvement of quality of life, response to treatment, and compliance of concurrent weekly cisplatin with intracavitary brachytherapy (ICRT) in patients with cervical carcinoma, pre-treated with concurrent chemo- radiotherapy. Materials and Methods: This study was conducted in the Department of Radiotherapy, Government Medical College, from October 2018 to March 2020, meeting specified inclusion and exclusion criteria; patients willing to participate in the study were included. Results: On analyzing the pattern of response, 91.0% of patients have a complete response. The incidence of nausea and vomiting was observed at grade 1 or 2 in 80.0% of patients, grade 3 in 17.0% of patients, and more than grade 3 in 3.0% of patients. Neutropenia is occurred at less than grade 3 in 30.0% of patients and grade 3 or more in 3.3% of patients. Vaginal mucositis was also observed in 85.0% of the patients in less than grade 3 and 11.6% in grade 3 or more. The incidence of renal dysfunction less than grade 3 was seen in 35.0% of the patients and grade 3 or more in 5.0% of the patients. After 6months, there was cystitis found in less than grade 3 in 10.0% of the patients and more than grade 3 in 3.3% of the patients. Conclusion: In locally advanced squamous cell carcinoma of the uterine cervix, the addition of concurrent injection of cisplatin to ICRT significantly improves locoregional response but increases the incidence of hematological and mucosal toxicity, which is manageable.
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Background: External beam radiotherapy with concurrent chemotherapy has become the mainstay of treatment for locally advanced head and neck cancers. Objective: The objective of this study was to compare paclitaxel to cisplatin as an agent for concurrent chemoradiation in locally advanced squamous cell carcinoma of head neck region in terms of toxicities and response to treatment. Materials and Methods: Biopsy-proven Stage III and Stage IVA head and neck squamous cell cancer patients were included in the study. The study arm patients received concurrent dose of paclitaxel 20 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients in the control arm received concurrent dose of cisplatin 30 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients of both arms received a total dose of 66 Gy external beam radiation, 200 cGy/day, 5 fractions in a week in 6.5 weeks treated on a Theratron 780E Cobalt-60 teletherapy unit. Results: Acute Grades III and IV renal toxicity and nausea were reported significantly more number of cases in cisplatin arm in comparison to paclitaxel arm. There was no statistically significant difference observed in the groups in terms of treatment response and failure pattern (χ2 = 3.63, df = 1, level of significance 0.05). On follow-up, up to 6 months, 51.85% of cases are disease free in the control arm and 50.66% of cases in the study arm. Conclusion: Low-dose weekly paclitaxel concurrent with external beam radiation therapy given in conventional fractionation is comparable to concurrent cisplatin in locally advanced head and neck squamous cell carcinoma in terms of efficacy. There is lower incidence of severe renal toxicity and vomiting with concurrent paclitaxel than with cisplatin.
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The study was conducted to understand the clinical algorithm of spinal meningioma. Correlation was done by clinical presentation with radiological features and histopathology .The stress upon to understand the necessity for a team-approach between Clinician, Radiologist and Pathologist and vice versa is emphasised. Aim: To correlate histopathology of spinal meningioma with the Clinical features. Methods: This is a retrospective study of spinal tumours, diagnosed by histopathology as various types of meningioma. All the relevant clinical data of the patients were searched from the ward records. The various Radiological features were collected. Results: The total number of spinal tumours studied during the 8 years period was 86 cases among which 25 cases were diagnosed by histopathology as various types of meningioma conclusively. Spectroscopy provides molecular information with regard to meningiomas and potentially aid in biopsy planning. Surgical resections were done as follows: 20 cases resected as Simpson Grade 1, 5 cases resected as Simpson Grade 2. Venous thromboembolism was seen in 1 patient. Four cases underwent follow up Adjuvant External Beam Radiotherapy. Conclusion: The Simpson grading of resection of meningioma correlated the degree of surgical resection completeness with symptomatic recurrence. Four cases underwent follow up Adjuvant External Beam Radiotherapy with good results .Spinal meningioma needs correlation between Radiologist, Pathologist and Clinician.
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Cervical cancer is one of the leading causes of cancer-related deaths in developing countries. Between 80% and 90% of cervical carcinomas are squamous cell carcinomas. Concurrent chemo radiation with Inj. Cisplatin given every week followed by intracavitary Brachytherapy has become the standard of treatment in locally advanced cervical carcinoma Methods: 60 biopsy proven cases of locally advanced cervical cancer attending the Out Patient Department of Radiotherapy from November 2017 to April 2019, meeting specified Inclusion and Exclusion Criteria, willing to participate in the study were included. Acute toxicities and locoregional control were assessed using the common terminology criteria for adverse events (CTCAE) version 4.0. During treatment patients will be reviewed weekly. After treatment completion, patients will be reviewed monthly for six months. And after that, they will be reviewed every 3 months for 9 months. Results: The median age was 50 years (range: 40–60 years) in both the arms. On analysing the pattern of response, in Arm A the number of patients having complete response was 29 (96.66%), partial response was 1 (3.34%). In the Arm B all patients have complete response. The incidence of Emesis, Dermatitis, Neutropenia, and Vaginal Mucocytis were more in Arm B as compared to Arm A. Conclusion: In locally advanced squamous cell carcinoma of uterine cervix, addition of concurrent injection Cisplatin to ICRT did not significantly improve loco regional response but increases incidence of haematological and mucosal toxicity, which being manageable, were not associated with increased mortality.
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Aim: The main purpose of this study is to evaluate the effect of dose perturbation due to common dental restoration materials in the head and neck radiotherapy with a 15 MV external photon beam. Setting and Design: Teeth with three dental restorations such as tooth filled with Amalgam, Ni-Cr alloy, and Ceramco were simulated by MCNPX Monte Carlo code. In this simulation, the dental materials were exposed by a 15 MV photon beam from a Siemens Primus linac, inside a water phantom. Materials and Methods: A Siemens Primus linear accelerator and a phantom including: tooth only, tooth with Amalgam, tooth with Ni-Cr alloy, and tooth with Ceramco were simulated by MCNPX Monte Carlo code, separately. The percentage dose change was evaluated relative to dose in water versus depth for these samples on the beam's central axis. The absolute dose by prescription of 100 cGy dose in water phantom at 3.0 cm depth was calculated for water, tooth, tooth with Amalgam, tooth with Ni-Cr alloy, and tooth with Ceramco. Results: The maximum percentage dose change is related to tooth with Ni-Cr alloy, tooth, tooth with Ceramco, and tooth with Amalgam with amounts of 7.73%, 6.95%, 4.7%, and 3.06% relative to water at 0.75 cm depth, respectively. When 100.0 cGy dose was prescribed at 3.1 cm, the maximum absolute dose was 201.0% in the presence of tooth with Ni-Cr alloy at 0.75 cm. Conclusion: Introduction of the compositions of dental restorations can improve the accuracy of dosimetric calculations in treatment planning and protect the healthy tissues surrounding teeth from a considerable overdose
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With the obvious improvement of the diagnosis and treatment level of thyroid cancer,the treatment methods of thyroid cancer have also been improved.The treatment of thyroid cancer is dominated by surgery,TSH inhibition therapy and radioactive iodine therapy. With the development of computer, imaging and radiotherapy equipment,radiotherapy has gradually become an important auxiliary treatment for thyroid cancer. For parts of the cases which operation could not thoroughly remove lesions or lost 131I treatment of thyroid cancer,external beam radiotherapy is increasingly being used for adjuvant therapy.Although external beam radiotherapy has gradually played a significant role,currently EBRT is not widely used in the clinic,and the therapeutic effect has been controversial yet in the treatment of thyroid cancer.
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Introduction : Ca Cervix is the second most common malignancy in Indian women. Most of the cases present in advanced stage. Radiotherapy is an important modality of treatment. Combination of EBRT and ICRT is an effective strategy which is based on the principle that we are able to give high radiation dose to tumor while sparing surrounding normal tissue.Aim and Objectives :The aim was to evaluate the 3 year overall survival (OS) and disease-free survival (DFS) of patients treated by EBRT and ICRT. The objectives were to evaluate radiation toxicities and to evaluate rate of residual disease, recurrence and distant metastases.Materials and Methods : It is a Retrospective analytical study. We analyzed 468 newly diagnosed cases of Ca Cervix registered in department between January2009 to December2013. Out of which 382 completed radical radiotherapy (EBRT+ICRT).Results : At the end of 3 years 58(15.18%) patients lost to follow-up, 48(12.56%) residual disease, 60(15.70%) local recurrence and 26(6.80%) had distant metastases. The DFS was 73.91% in Stage-I and 62.8% in Stage-II while 51.38% in Stage-III and 29.82% in Stage-IV. The OS was 82.6% in Stage-I, 71.9% in Stage-II, 65.19% in Stage-III and 42.1% in Stage-IV. The difference between early and advanced disease is statistically significant with p-value of 0.016. Conclusions : EBRT and ICRT is effective treatment in terms of overall survival and disease-free survival. Associated radiation induced rectal and bladder toxicities are acceptable & manageable. Early stage and overall treatment time are favorable prognostic factors for 3 year DFS & OS.
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Objective To investigate the relationship between acute radiation proctitis and radiation dose,volume as well as radiation time,in the process of intensity-modulated radiation therapy (IMRT) for the cervical cancer patients.Methods A total of 51 patients with locally advanced cervical cancer were enrolled from January 2011 to December 2013.Those patients were then classified into grade 1 to 4 groups,according to the RTOG/EORTCtoxicity grading standard.The exposure dose volume and the average dose of rectum under the standard plan were evaluated with dose-volume histogram (DVH).The ANOVA test was used for analyzing Dmax,D mean,D1 cm3,D2cm3,D40 and V40 values of rectum and the average exposure dose of rectum.Results The average time of acute radiation proctitis with clinical symptoms was (23.06 ± 12.01) d after radiotherapy.Dmaxvalues of rectum in grade 2 group was lower than those in grade 3 and 4 groups (F =5.268,P ＜ 0.05).Moreover,D1 cm3 and D2 cm3 values of rectum in grade 1 and 2 groups were also lower than those in grade 3 and 4 groups (F =4.893,4.406,P ＜ 0.05).There was no statistically significant difference between D40 and V40 values.Conclusions The acute radiation proctitis could be frequently found around 20 days during the IMRT for cervical cancer patients.Mild and moderate acute radiation proctitis are more common,while severe acute radiation proctitis is rare.Minimizing Dmax,D1 cm3 and D2 cm3 values of rectum might reduce the incidence of severe acute radiation proctitis in cervical cancer patients receiving IMRT.
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Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective: To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods: In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m2 on day 1 followed by 5-fluorouracil 500 mg/m2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results: Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion: A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients.
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The risk of radiotherapy-related secondary cancers in children with constitutional retinoblastoma 1 (RB1) mutations has led to reduced use of external beam radiotherapy (EBRT) for RB. Presently, tumor reduction with chemotherapy with or without focal surgery (chemosurgery) is most commonly undertaken; EBRT is avoided as much as possible and is considered only as the last treatment option prior to enucleation. Nevertheless, approximately 80% of patients are diagnosed at a locally advanced stage, and only 20-25% of early stage RB patients can be cured with a chemosurgery strategy. As a whole, chemotherapy fails in more than two-thirds of eyes with advanced stage disease, requiring EBRT or enucleation. Radiotherapy is still considered necessary for patients with large tumor(s) who are not candidates for chemosurgery but who have visual potential. When radiation therapy is indicated, the lowest possible radiation dose combined with systemic or local chemotherapy and focal surgery may yield the best clinical outcomes in terms of local control and treatment-related toxicity. Proton beam therapy is one EBRT method that can be used for treatment of RB and reduces the radiation dose delivered to the adjacent orbital bone while maintaining an adequate dose to the tumor. To maximize the therapeutic success of treatment of advanced RB, the possibility of integrating radiotherapy at early stages of treatment may need to be discussed by a multidisciplinary team, rather than considering EBRT as only a last treatment option.
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Child , Child, Preschool , Humans , Eye Neoplasms/genetics , Genes, Retinoblastoma/genetics , Radiotherapy Dosage , Retinal Neoplasms/radiotherapy , Retinoblastoma/geneticsABSTRACT
Breast cancer is the most common disease in women worldwide, which not only threatened the women’s survival time, but also inlfuenced their quality of life as well. Within this challenge, it’s important to optimize the current multidisciplinary treatment stratagem for breast cancer. Radiotherapy is one of the most important treatment modality for patients with breast cancer, with the trend to shrink the irradiated volume and shorten the total fraction times in recent years. Intraoperative radiation therapy (IORT) as a fast and convenient procedure has the ability to deliver a high, single-fraction radiation dose to tumor beds with minimal exposure of surrounding tissues (lung, heart, etc.), which could be displaced or shielded right after the tumor removal during the surgical procedure. Right now, IORT has been either integrated as a boost technique in multimodal approaches using postoperative EBRT in the treatment of early breast cancer patients undergoing breast conservation surgery or used as a single dose accelerated partial breast irradiation technique for these patients. This review discussed the rationale of IORT, the beneifts and limitations of IORT, the indication and the clinical results of this procedure, including treatment related side-effects as well in order to provide the preliminary evidence based approach for early breast cancer patients.
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PURPOSE: External beam radiotherapy (EBRT) plays a controversial role in the management of differentiated thyroid cancer. We reviewed the outcomes of patients at our institution who had been treated with EBRT for advanced differentiated thyroid cancer. METHODS: Subjects included 35 patients who received thyroidectomy and EBRT at Yonsei University Wonju College of Medicine, Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from January 1989 to September 2011. RESULTS: The 5 year overall locoregional control rate was 74.4%. No significant differences were found in locoregional progression- free survival for patients with complete resection, microscopic residual disease, or gross residual disease. CONCLUSION: The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced papillary thyroid cancer, even with gross residual disease.
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Humans , Diagnosis , Radiotherapy , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Objective To develop a brachtherapy (BT) dose calculation program based on AAPM TG-43UI formula.With this program we can combine the dose result of external beam radiotherapy (EBRT) and BT together which is calculated by the different treatment planning TPS.Methods BT treatment data, such as source parameter, dwelling position and dwelling time, are retrieved from Nucletron Plato planning system and converted to ADAC planning system coordinate.The BT 3D dose distribution is re-calculated as well.Then the 3D dose distribution is exported to ADAC planning system.In that way, ADAC planning system can display either the EBRT dose or the BT dose and the combined dose can be calculated, displayed and evaluated as well.Results BT dose calculation result of our program which based on AAPM TG-43UI formula is identical with which of Plato (<0.1%).Furthermore, the BT dose can be transfer to the ADAC easily and the dose distributions of combined therapy can be merged in ADAC.Conclusions Our program can be used to combine the dose result of EBRT and BT from different TPS.
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The authors reviewed their experiences of external beam radiotherapy (EBR) as an initial treatment in retinoblastoma patients to determine its long-term effect on subsequent tumor control and complications. A total of 32 eyes in 25 patients that underwent EBR for retinoblastoma were reviewed retrospectively. The patients consisted of 21 boys and 4 girls of median age at treatment of 7.1 months. Radiation doses ranged from 35 to 59.4 Gy. The 10-yr ocular and patient survivals were 75.4% and 92.3%, respectively. Nine of the 32 eyes progressed; 7 of these were enucleated and 2 were salvaged by focal treatment. According to the Reese-Ellsworth classification, 4 of 5 eyes of Group II, 13 of 16 Group III eyes, 2 of 4 Group IV eyes, and 5 of 7 Group V eyes were retained, and of the 32 eyes, 13 had visual acuity better than 20/200. Eleven patients experienced a radiation-induced complication. No patient developed a second malignancy during follow-up. Despite the limited number of patients enrolled, EBR may provide a mean of preserving eyeball and vision for some advanced lesions.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Eye Enucleation , Korea , Radiotherapy/methods , Radiotherapy Dosage , Retinal Neoplasms/radiotherapy , Retinoblastoma/radiotherapy , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
OBJETIVO: Avaliar a necessidade de monitoração semanal, pela contagem de leucócitos e plaquetas, dos pacientes portadores de câncer das áreas de cabeça e pescoço, tórax e pelve submetidos a radioterapia externa convencional. MATERIAIS E MÉTODOS: Cento e um adultos, portadores de câncer das áreas de cabeça e pescoço (11 pacientes), tórax (35 pacientes) e pelve (55 pacientes), submetidos a radioterapia, avaliados semanalmente com leucograma e contagem de plaquetas, comparando-se as contagens das células antes do início do tratamento com as obtidas nas semanas ao longo do tratamento, área tratada, sexo e faixa etária. RESULTADOS: A maior queda dos leucócitos e plaquetas ocorreu na quarta semana, quando linfócitos, leucócitos totais, neutrófilos, monócitos e plaquetas apresentaram diminuição de 53,5 por cento, 26,8 por cento, 19,4 por cento, 22,2 por cento e 14,6 por cento, respectivamente, ao serem comparados aos valores do início do tratamento. Durante o tratamento, as médias geométricas da pelve foram estatisticamente menores do que as de tórax e cabeça e pescoço. Os linfócitos foram os mais sensíveis à irradiação. Não houve alteração da contagem de leucócitos e plaquetas relacionadas ao sexo ou à faixa etária. CONCLUSÃO: A partir dos resultados obtidos não parece ser necessária a contagem semanal de leucócitos e plaquetas para pacientes submetidos a radioterapia externa convencional em campos localizados.
OBJECTIVE: To evaluate the necessity of weekly monitoring by means of leukocyte and platelet counts of patients with head and neck, chest, and pelvis cancer submitted to conventional radiotherapy. MATERIALS AND METHODS: A hundred and one adult patients with cancer of head and neck (n = 11), chest (n = 35) and pelvis (n = 55), submitted to radiotherapy were assessed by means of leukocyte and platelet counts on a weekly basis, with a comparison between the results before and during the treatment and in correlation with the area treated, patient's sex and age group. RESULTS: The most significant decrease in leukocytes was observed in the fourth week, when lymphocytes, total leukocytes, neutrophils, monocytes and platelets presented a decrease of 53.5 percent, 26.8 percent, 19.4 percent, 22.2 percent and 14.6 percent, respectively, in comparison with the values found before the beginning of the therapy. Geometric means for pelvis during the treatment were lower than those for chest, and head and neck. Lymphocytes demonstrated to be more sensitive to radiation therapy. No alteration was found in leukocyte or platelet counts in correlation with patients' sex or age. CONCLUSION: Based on the results of the present study, weekly leukocyte and platelet counts do not seem to be useful in the assessment patients submitted to conventional radiotherapy for localized cancer.
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Humans , Male , Female , Adult , Middle Aged , Blood Cell Count , Blood Cell Count/methods , Leukocyte Count , Radiotherapy/adverse effects , Radiotherapy/methods , Neoplasms/blood , Platelet Count , ToxicityABSTRACT
PURPOSE: The best treatment for advanced esophageal cancer is chemoradiotherapy followed by surgery. In spite of the advance of multimodality therapy, most patients with esophageal cancer are treated with radiation therapy alone. This study reports the outcome of the use of conventional external beam radiotherapy alone for the treatment of esophageal cancer. MATERIALS AND METHODS: Between January 1998 and December 2005, 30 patients with squamous cell carcinoma of the esophagus were treated with external beam radiotherapy using a total dose exceeding 40 Gy. Radiotherapy was delivered with a total dose of 44-60 Gy (median dose, 57.2 Gy) over 36~115 days (median time, 45 days). Thirteen patients (43.3%) had a history of disorders such as diabetes, hypertension, tuberculosis, lye stricture, asthma, cerebral infarct, and cancers. Four patients metachronously had double primary cancers. The most common location of a tumor was the mid-thoracic portion of the esophagus (56.7%). Tumor lengths ranged from 2 cm to 11 cm, with a median length of 6 cm. For AJCC staging, stage III was the most common (63.3%). Five patients had metastases at diagnosis. RESULTS: The median overall survival was 8.3 months. The survival rates at 1-year and 2-years were 33.3% and 18.7%, respectively. The complete response rate 1~3 months after radiotherapy was 20% (6/30) and the partial response rate was 70% (21/30). Sixteen patients (53.3%) had an improved symptom of dysphagia. Significant prognostic factors were age, tumor length, stage, degree of dysphagia at the time of diagnosis and tumor response. Cox regression analysis revealed the aim of treatment, clinical tumor response and tumor length as independent prognostic factors for overall survival. Twenty-eight patients had local failure and another four patients had metastases. Three patients were detected with double primary cancers in this analysis. A complication of esophageal stricture was observed in three patients (10%), and radiation pneumonitis occurred in two patients (6.7%). CONCLUSION: The prognosis of esophageal cancer remains poor, in spite of advances in radiotherapy techniques. Radiotherapy is one of the main treatment modalities for the relief of dysphagia and treatment related complications are minimal. It is expected that the addition of chemotherapy or another systemic modality to radiotherapy will improve tumor control and increase the survival rate in advanced esophageal cancer.
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Chemoradiotherapy , Neoplasm Metastasis , Esophageal NeoplasmsABSTRACT
PURPOSE: We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. METHODS AND MATERIALS: One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (9 4%) and ranged from 1 month to 92 months (median; 6 months). RESULTS: The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration o f the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rte was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except fo 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 rnonths and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less turnor length and those with more than 5 cm tumor length was rnarginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). CONCLUSION: The survival outcome for advanced esophageal cancer patients treated by external be am radiotherapy alone was very poor, In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.