ABSTRACT
PURPOSE: To study efficacy and toxicity of radiochemotherapy in esophageal cancer including initial endoluminal high-dose-rate brachytherapy (HDR-BT). PATIENTS AND METHODS: Between 01/1995 and 06/2005, 61 patients with esophageal cancer were treated preoperatively with definitive and palliative intent. Treatment started with intraluminal HDR-BT for recanalization of the esophagus (single fraction size of 8 Gy in 0.5 cm depth, three times, q7d) followed by external-beam radiation therapy (50 Gy total dose, 5 x 2 Gy/week, 25 fractions in 5 weeks). Chemotherapy was started simultaneously with external irradiation (three courses of cisplatin and 5-fluorouracil, q21d). RESULTS: Swallowing function improved in 55/61 patients (dysphagia classification according to the RTOG), and worsened in 6/61 patients, respectively. Median duration of symptomatic improvement was 11 months, median follow-up 12 months (range 3-68 months). Following simultaneous radiochemotherapy, tumor resectability was achieved in 7/25 patients of the neoadjuvant group, and the histological specimen showed complete remission in 6/7 patients. CONCLUSION: These results indicate a favorable effect of simultaneous radiochemotherapy starting with endoluminal HDR-afterloading-( AL-)BT in esophageal cancer.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Brachytherapy/methods , Esophageal Neoplasms/radiotherapy , Radiotherapy, Conformal/methods , Adult , Aged , Aged, 80 and over , Brachytherapy/adverse effects , Cisplatin/administration & dosage , Combined Modality Therapy/methods , Deglutition Disorders/etiology , Deglutition Disorders/prevention & control , Female , Fluorouracil/administration & dosage , Humans , Male , Middle Aged , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Radiotherapy, Conformal/adverse effects , Treatment OutcomeABSTRACT
AIM: To prove the efficacy of the simultaneous radio-chemotherapy of the inoperable or non-resectable esophageal cancer. METHODS: Twenty-nine patients with inoperable or non-resectable oesophageal cancer were treated between January 1995 and December 2002. The therapy was started with intraluminal HDR AL irradiation for the recanalisation of the esophagus (8 Gy at 0.5 cm depth, repeated two-three times, with one-week interval), followed by percutaneous megavolt irradiation one week after the last HDR AL session (50 Gy total dose, 5 x 2 Gy/week fractions for 5 weeks). The chemotherapy was started simultaneously with the percutaneous megavolt irradiation (three courses of Cisplatin-5-Fluorouracil combination, with four-week intervals). RESULTS: The swallow function has been improved in 16/29 patients, it remained unchanged in 10/29 and got worse in 3/29 patients (1 and 3 Units), respectively. REMISSION: complete 9/29 patients, partial 17/29 patients. Side effects: Esophagitis of different degree occurred in all patients, consecutive transitory dysphagia developed in 8/29 patients, leucopenia after the chemotherapy in 2/29 patients, tracheo-esophageal fistula in 3/29 patients. Follow-up time: average 12.2 months (3-55 months). The duration of the swallow function improvement: average 10.7 months (2-55 months). CONCLUSION: The initial results refer to the favourable effect of the palliative radio-chemotherapy of the inoperable esophageal cancer.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Adult , Aged , Chemotherapy, Adjuvant , Cisplatin/administration & dosage , Cisplatin/adverse effects , Deglutition/drug effects , Deglutition/radiation effects , Deglutition Disorders/etiology , Drug Administration Schedule , Esophagitis/etiology , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Follow-Up Studies , Humans , Male , Middle Aged , Palliative Care/methods , Radiotherapy Dosage , Radiotherapy, Adjuvant/methods , Remission Induction , Retrospective Studies , Treatment OutcomeABSTRACT
AIM: to demonstrate the simultaneous radio-chemotherapy of primary esophageal malignant melanoma on the basis of one case. PATIENT AND METHODS: 68-years-old male patient with malignant melanoma in middle part of the esophagus. The therapy was started with intraluminal high-dose-rate afterloading brachytherapy for the recanalisation of the esophagus (8 Gy in 0.5 cm deep), followed by percutaneous megavolt therapy two weeks after the last HDR AL session (50 Gy total dose, 5 x 2 Gy/week fractions for 5 week, 3D conformal planning). The chemotherapy was started simultaneously with the percutaneous megavolt irradiation (three courses of Cisplatin-5-Fluorouracil combination, repeated in four-week intervals). After the radio-chemotherapy a supraclavicular metastasis was verified, so the radio-chemotherapy was followed with megavolt therapy of the metastasis at 30 Gy dose (5 x 2 Gy/week fractions), and chemotherapy (Cisplatin-Dacarbazine combination in 6-session, four-week intervals) and after them immunotherapy was started. RESULTS: The swallow function has been improved, the supraclavicular metastasis was in partial remission. After the beginning of the radio-chemotherapy the swallow function was good for 16 months, and 18 months after the beginning of radio-chemotherapy the patient died due to pulmonary and hepatic dissemination. CONCLUSION: Radio-chemotherapy of esophageal malignant melanoma has favorable palliative effect with acceptable quality of life.
