High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer

Nonoshita, Takeshi; Sasaki, Takahiro; Hayashi, Hideki; Toh, Yasushi; Shioyama, Yoshiyuki; Nakamura, Katsumasa; Honda, Hiroshi

doi:10.1007/s11604-007-0152-4

Cited by 17 publications

(7 citation statements)

References 14 publications

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“…23) Recently, Nonoshita et al reported a curative high-doserate brachytherapy with or without chemotherapy for six previously irradiated patients with recurrent superficial esophageal cancer; no severe complications were observed, and local control was achieved in 5 of 6 patients. 24) In our curative group, the patients had a T1-2 tumor, a tumor size of less than 4 cm, and few severe complications; only one patient had a Grade 3 esophageal perforation, and 10 (91%) of 11 patients had an objective response and the median overall survival time was 19 months. We found that in the patients of the curative group, our multimodal approach including re-irradiation is feasible with acceptable toxicity and a potential value of a promising treatment for the longterm survival of some patients.…”

Section: Discussionmentioning

confidence: 81%

Multimodal Approaches Including Three-dimensional Conformal Re-irradiation for Recurrent or Persistent Esophageal Cancer: Preliminary Results

Yamaguchi

Ohguri

Imada³

et al. 2011

JRR

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The purpose of this study was to assess the toxicity and efficacy of multimodal approaches, including three-dimensional conformal re-irradiation, for patients with recurrent or persistent esophageal cancer after radiotherapy. Thirty-one patients with esophageal cancer treated with three-dimensional conformal re-irradiation were retrospectively analyzed. Of the 31 patients, 27 patients received concurrent chemotherapy, and 14 patients underwent regional hyperthermia during the re-irradiation. We divided the patients into two groups on the basis of their clinical condition: the curative group (n = 11) or the palliative group (n = 20). Severe toxicities were detected in one patient with Grade 3 esophageal perforation in the curative group, and 5 patients had a Grade 3 or higher toxicity of the esophagus in the palliative group. Advanced T stage at the time of re-irradiation was found to be significantly correlated with Grade 3 or higher toxicity in the esophagus. For the curative group, 10 (91%) of 11 patients had an objective response. For the palliative group, symptom relief was recognized in 8 (57%) of 14 patients with obvious swallowing difficulty. In conclusion, in the curative group with early-stage recurrent or persistent esophageal cancer, the multimodal approaches, including three-dimensional conformal re-irradiation, may be feasible, showing acceptable toxicity and a potential value of promising results, although further evaluations especially for the toxicities of the organs at risk are required. In the palliative group, the benefit of our therapy may be restrictive because severe esophageal toxicities were not uncommon in the patients with advanced T stage at the time of re-irradiation.

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Section: Discussionmentioning

confidence: 81%

Multimodal Approaches Including Three-dimensional Conformal Re-irradiation for Recurrent or Persistent Esophageal Cancer: Preliminary Results

Yamaguchi

Ohguri

Imada³

et al. 2011

JRR

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“…It was not known whether re-irradiation definitely increased the risk of esophageal perforation. The treatment options after local recurrence includes surgery, chemotherapy and RT [ 15 – 17 ], and data about patients receiving re-irradiation is rare [ 18 ]. For various reasons, patients with local recurrence in our study did not receive surgery.…”

Section: Discussionmentioning

confidence: 99%

Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

Chen

et al. 2014

Journal of Radiation Research

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The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0–3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose >100 Gy (biologically effective dose−10), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor.

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“…Nonoshita et al [12] reported 6 patients with recurrent esophageal cancer after external radiotherapy (median dose, 60 Gy). T stage at the time of primary radiotherapy and recurrence was T1 in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the literatures, the median overall survival after re-RT of recurrent esophageal cancer after primary definitive radiotherapy was 6.5-30.0 months [11,12] (Table 4). …”

Section: Discussionmentioning

confidence: 99%

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Re-irradiation of recurrent esophageal cancer after primary definitive radiotherapy

et al. 2012

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PurposeFor recurrent esophageal cancer after primary definitive radiotherapy, no general treatment guidelines are available. We evaluated the toxicities and clinical outcomes of re-irradiation (re-RT) for recurrent esophageal cancer.Materials and MethodsWe analyzed 10 patients with recurrent esophageal cancer treated with re-RT after primary definitive radiotherapy. The median time interval between primary radiotherapy and re-RT was 15.6 months (range, 4.8 to 36.4 months). The total dose of primary radiotherapy was a median of 50.4 Gy (range, 50.4 to 63.0 Gy). The total dose of re-RT was a median of 46.5 Gy (range, 44.0 to 50.4 Gy).ResultsThe median follow-up period was 4.9 months (range, 2.6 to 11.4 months). The tumor response at 3 months after the end of re-RT was complete response (n = 2), partial response (n = 1), stable disease (n = 2), and progressive disease (n = 5). Grade 5 tracheoesophageal fistula developed in three patients. The time interval between primary radiotherapy and re-RT was less than 12 months in two of these three patients. Late toxicities included grade 1 dysphagia (n = 1).ConclusionRe-RT of recurrent esophageal cancer after primary radiotherapy can cause severe toxicity.

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High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer

Abstract: These data suggest that HDR brachytherapy is an effective and safe treatment for patients with recurrent esophageal cancer after external radiotherapy.

Cited by 17 publications

References 14 publications

Multimodal Approaches Including Three-dimensional Conformal Re-irradiation for Recurrent or Persistent Esophageal Cancer: Preliminary Results

Multimodal Approaches Including Three-dimensional Conformal Re-irradiation for Recurrent or Persistent Esophageal Cancer: Preliminary Results

Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

Re-irradiation of recurrent esophageal cancer after primary definitive radiotherapy

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