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31.05.2016 | Original Article

High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer

Experience from a large single-center cohort

verfasst von: Nils H. Nicolay, M.D., Ph.D., Johanna Rademacher, M.D., Jan Oelmann-Avendano, M.D., Jürgen Debus, M.D., Ph.D., Peter E. Huber, M.D., Ph.D., Katja Lindel, M.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 7/2016

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Abstract

Purpose

The aim of this work was to evaluate outcomes and toxicities of high dose-rate (HDR) endoluminal brachytherapy in a cohort of esophageal cancer patients.

Patients and methods

We analyzed the records of 36 patients treated with HDR brachytherapy for histologically confirmed esophageal cancer. Brachytherapy was either applied as a boost treatment for definitive treatment regimens or as salvage therapy for recurrent tumors with single doses between 4 and 6 Gy. Survival and toxicities were retrospectively analyzed.

Results

Brachytherapy was performed as initially planned in all but one patient; 18 patients had a complete endoscopic response at the first follow-up examination. Locoregional recurrence was observed in 24 patients after a median time of 3 months; 1‑ and 2‑year recurrence-free survival rates were 51 and 51 % for the patients treated for primary tumors and 11 and 6 % for patients treated for tumor recurrence, respectively. Median overall survival was 18 months; estimated overall survival rates at 1, 2, and 3 years were 63, 50, and 30 % after primary brachytherapy, and 60, 25, and 6 % after recurrence therapy. Adenocarcinoma histology, non-complete remission after treatment, and treatment for recurrent cancers were associated with significantly reduced prognoses. Mild dysphagia was the most common side effect in 17 patients; 8 patients suffered from locoregional grade 3 toxicities, and no grade 4 or 5 toxicities were observed.

Conclusions

Endoluminal brachytherapy during the course of esophageal cancer treatment can be safely applied and results in good functional outcomes regarding dysphagia with low rates of severe toxicities.

Pennathur A, Gibson MK, Jobe BA, Luketich JD (2013) Oesophageal carcinoma. Lancet 381(9864):400–412CrossRefPubMed

Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63(1):11–30CrossRefPubMed

Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349(23):2241–2252CrossRefPubMed

Lagergren J, Lagergren P (2013) Recent developments in esophageal adenocarcinoma. CA Cancer J Clin 63(4):232–248CrossRefPubMed

Wheeler JB, Reed CE (2012) Epidemiology of esophageal cancer. Surg Clin North Am 92(5):1077–1087CrossRefPubMed

Hagen P van, Hulshof MC, Lanschot JJ van, Steyerberg EW, Berge Henegouwen MI van, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084CrossRefPubMed

Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, Kiel K, Willett C, Sugarbaker D, Mayer R (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26(7):1086–1092CrossRefPubMed

Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J, Australasian Gastro-Intestinal Trials G (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8(3):226–234CrossRefPubMed

Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA, Kelsen DP (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20(5):1167–1174CrossRefPubMed

10.

Roeder F, Nicolay NH, Nguyen T, Saleh-Ebrahimi L, Askoxylakis V, Bostel T, Zwicker F, Debus J, Timke C, Huber PE (2014) Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer. Radiat Oncol 9:191CrossRefPubMedPubMedCentral

11.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics. CA Cancer J Clin 59(4):225–249CrossRefPubMed

12.

Haefner MF, Lang K, Krug D, Koerber SA, Uhlmann L, Kieser M, Debus J, Sterzing F (2015) Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy. J Radiat Res 56(4):742–749CrossRefPubMedPubMedCentral

13.

Chao YK, Chan SC, Chang HK, Liu YH, Wu YC, Hsieh MJ, Tseng CK, Liu HP (2009) Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus. Eur J Surg Oncol 35(3):289–294CrossRefPubMed

14.

Nakamura T, Hayashi K, Ota M, Eguchi R, Ide H, Takasaki K, Mitsuhashi N (2004) Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg 188(3):261–266CrossRefPubMed

15.

Dai Y, Li C, Xie Y, Liu X, Zhang J, Zhou J, Pan X, Yang S (2014) Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev 10:CD005048PubMed

16.

Wong Hee Kam S, Rivera S, Hennequin C, Lourenco N, Chirica M, Munoz-Bongrand N, Gornet JM, Quero L (2015) Salvage high-dose-rate brachytherapy for esophageal cancer in previously irradiated patients: a retrospective analysis. Brachytherapy 14(4):531–536CrossRefPubMed

17.

Okamoto H, Aikawa A, Wakita A, Yoshio K, Murakami N, Nakamura S, Hamada M, Abe Y, Itami J (2014) Dose error from deviation of dwell time and source position for high dose-rate 192Ir in remote afterloading system. J Radiat Res 55(4):780–787CrossRefPubMedPubMedCentral

18.

Gaspar LE, Winter K, Kocha WI, Coia LR, Herskovic A, Graham M (2000) A phase I/II study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207): final report. Cancer 88(5):988–995CrossRefPubMed

19.

Brunner TB, Rupp A, Melzner W, Grabenbauer GG, Sauer R (2008) Esophageal cancer. A prospective phase II study of concomitant-boost external-beam chemoradiation with a top-up endoluminal boost. Strahlenther Onkol 184(1):15–22CrossRefPubMed

20.

Muijs CT, Beukema JC, Mul VE, Plukker JT, Sijtsema NM, Langendijk JA (2012) External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma. Radiother Oncol 102(2):303–308CrossRefPubMed

21.

Vuong T, Szego P, David M, Evans M, Parent J, Mayrand S, Corns R, Burtin P, Faria S, Devic S (2005) The safety and usefulness of high-dose-rate endoluminal brachytherapy as a boost in the treatment of patients with esophageal cancer with external beam radiation with or without chemotherapy. Int J Radiat Oncol Biol Phys 63(3):758–764CrossRefPubMed

22.

Kachnic LA, Winter K, Wasserman T, Kelsen D, Ginsberg R, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA et al (2011) Longitudinal quality-of-life analysis of RTOG 94-05 (int 0123): a phase III trial of definitive chemoradiotherapy for esophageal cancer. Gastrointest Cancer Res 4(2):45–52PubMedPubMedCentral

23.

Geh JI, Bond SJ, Bentzen SM, Glynne-Jones R (2006) Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol 78(3):236–244CrossRefPubMed

24.

Fakhrian K, Oechsner M, Kampfer S, Schuster T, Molls M, Geinitz H (2013) Advanced techniques in neoadjuvant radiotherapy allow dose escalation without increased dose to the organs at risk: planning study in esophageal carcinoma. Strahlenther Onkol 189(4):293–300CrossRefPubMed

25.

Nicolini G, Ghosh-Laskar S, Shrivastava SK, Banerjee S, Chaudhary S, Agarwal JP, Munshi A, Clivio A, Fogliata A, Mancosu P et al (2012) Volumetric modulation arc radiotherapy with flattening filter-free beams compared with static gantry IMRT and 3D conformal radiotherapy for advanced esophageal cancer: a feasibility study. Int J Radiat Oncol Biol Phys 84(2):553–560CrossRefPubMed

26.

Aggarwal A, Harrison M, Glynne-Jones R, Sinha-ray R, Cooper D, Hoskin PJ (2015) Combination external beam radiotherapy and intraluminal brachytherapy for non-radical treatment of oesophageal carcinoma in patients not suitable for surgery or chemoradiation. Clin Oncol 27(1):56–64CrossRef

27.

Harms W, Krempien R, Grehn C, Berns C, Hensley FW, Debus J (2005) Daytime pulsed dose rate brachytherapy as a new treatment option for previously irradiated patients with recurrent oesophageal cancer. Br J Radiol 78(927):236–241CrossRefPubMed

28.

Sharma V, Mahantshetty U, Dinshaw KA, Deshpande R, Sharma S (2002) Palliation of advanced/recurrent esophageal carcinoma with high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 52(2):310–315CrossRefPubMed

29.

Sur RK, Levin CV, Donde B, Sharma V, Miszczyk L, Nag S (2002) Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma – an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys 53(1):127–133CrossRefPubMed

30.

Shridhar R, Almhanna K, Meredith KL, Biagioli MC, Chuong MD, Cruz A, Hoffe SE (2013) Radiation therapy and esophageal cancer. Cancer Control 20(2):97–110PubMed

31.

Murakami Y, Nagata Y, Nishibuchi I, Kimura T, Kenjo M, Kaneyasu Y, Okabe T, Hashimoto Y, Akagi Y (2012) Long-term outcomes of intraluminal brachytherapy in combination with external beam radiotherapy for superficial esophageal cancer. Int J Clin Oncol 17(3):263–271CrossRefPubMed

32.

Gaspar LE, Qian C, Kocha WI, Coia LR, Herskovic A, Graham M (1997) A phase I/II study of external beam radiation,achytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 92-07): preliminary toxicity report br. Int J Radiat Oncol Biol Phys 37(3):593–599CrossRefPubMed

33.

Folkert MR, Cohen GN, Wu AJ, Gerdes H, Schattner MA, Markowitz AJ, Ludwig E, Ilson DH, Bains MS, Zelefsky MJ et al (2013) Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients. Brachytherapy 12(5):463–470CrossRefPubMed

34.

Nonoshita T, Sasaki T, Hirata H, Toh Y, Shioyama Y, Nakamura K, Honda H (2007) High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer. Radiat Med 25(8):373–377CrossRefPubMed

35.

Gaspar LE, Nag S, Herskovic A, Mantravadi R, Speiser B (1997) American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Clinical Research Committee, American Brachytherapy Society, Philadelphia, PA. Int J Radiat Oncol Biol Phys 38(1):127–132CrossRefPubMed

36.

Homs MY, Steyerberg EW, Eijkenboom WM, Tilanus HW, Stalpers LJ, Bartelsman JF, Lanschot JJ van, Wijrdeman HK, Mulder CJ, Reinders JG et al (2004) Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet 364(9444):1497–1504CrossRefPubMed

37.

Bergquist H, Wenger U, Johnsson E, Nyman J, Ejnell H, Hammerlid E, Lundell L, Ruth M (2005) Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus 18(3):131–139CrossRefPubMed

38.

Rupinski M, Zagorowicz E, Regula J, Fijuth J, Kraszewska E, Polkowski M, Wronska E, Butruk E (2011) Randomized comparison of three palliative regimens including brachytherapy, photodynamic therapy, and APC in patients with malignant dysphagia (CONSORT 1a) (Revised II). Am J Gastroenterol 106(9):1612–1620CrossRefPubMed

39.

Zhu HD, Guo JH, Mao AW, Lv WF, Ji JS, Wang WH, Lv B, Yang RM, Wu W, Ni CF et al (2014) Conventional stents versus stents loaded with (125)iodine seeds for the treatment of unresectable oesophageal cancer: a multicentre, randomised phase 3 trial. Lancet Oncol 15(6):612–619CrossRefPubMed

40.

Lettmaier S, Strnad V (2014) Intraluminal brachytherapy in oesophageal cancer: defining its role and introducing the technique. J Contemp Brachytherapy 6(2):236–241CrossRefPubMedPubMedCentral

41.

Welsh J, Palmer MB, Ajani JA, Liao Z, Swisher SG, Hofstetter WL, Allen PK, Settle SH, Gomez D, Likhacheva A et al (2012) Esophageal cancer dose escalation using a simultaneous integrated boost technique. Int J Radiat Oncol Biol Phys 82(1):468–474CrossRefPubMed

42.

Yin L, Wu H, Gong J, Geng JH, Jiang F, Shi AH, Yu R, Li YH, Han SK, Xu B et al (2012) Volumetric-modulated arc therapy vs. c‑IMRT in esophageal cancer: a treatment planning comparison. World J Gastroenterol 18(37):5266–5275PubMedPubMedCentral

43.

Yu WW, Zhu ZF, Fu XL, Zhao KL, Mao JF, Wu KL, Yang HJ, Fan M, Zhao S, Welsh J (2014) Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma: early results of a phase II study. Strahlenther Onkol 190(11):979–986CrossRefPubMed

44.

Kim YS, Lee CG, Kim KH, Kim T, Lee J, Cho Y, Koom WS (2012) Re-irradiation of recurrent esophageal cancer after primary definitive radiotherapy. Radiat Oncol J 30(4):182–188CrossRefPubMedPubMedCentral

45.

Fakhrian K, Gamisch N, Schuster T, Thamm R, Molls M, Geinitz H (2012) Salvage radiotherapy in patients with recurrent esophageal carcinoma. Strahlenther Onkol 188(2):136–142CrossRefPubMed

46.

Yamaguchi S, Ohguri T, Imada H, Yahara K, Moon SD, Higure A, Yamaguchi K, Yoshikawa I, Harada M, Korogi Y (2011) Multimodal approaches including three-dimensional conformal re-irradiation for recurrent or persistent esophageal cancer: preliminary results. J Radiat Res 52(6):812–820CrossRefPubMed

47.

Fernandes A, Berman AT, Mick R, Both S, Lelionis K, Lukens JN, Ben-Josef E, Metz JM, Plastaras JP (2015) A prospective study of proton beam reirradiation for esophageal cancer. Int J Radiat Oncol Biol Phys 95(1):483–487CrossRefPubMed

Titel: High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer
Experience from a large single-center cohort
verfasst von: Nils H. Nicolay, M.D., Ph.D.
Johanna Rademacher, M.D.
Jan Oelmann-Avendano, M.D.
Jürgen Debus, M.D., Ph.D.
Peter E. Huber, M.D., Ph.D.
Katja Lindel, M.D.
Publikationsdatum: 31.05.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 7/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-0979-7

Springer Medizin

High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer

Experience from a large single-center cohort