25 Oesophageal Cancer
Oesophageal Cancer Brachytherapy
19
THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 10/06/2019
Table 27.2 A: External beam radiotherapy (EBRT) and endoluminal brachytherapy (BT) – curative indications in superficial oesophageal cancer.
Study
Patients (N)
Follow-up (months)
Procedure (BT type; doses)
Endpoint (at 5 years)
Murakami
87
94
EBRT 54-60 Gy plus #HDR boost(mucosal vs submu- cosal) prescribed brachytherapy dose was 10 Gy (2-4 fractions) or 7.5-15 Gy (3 fractions); in 27 pts. HDR alone 25-36 Gy in 5-18 fractions) EBRT 56-60 Gy plus #BT boost (HDR vs LDR) (3x3 Gy vs 2x5Gy with no difference, p=0.63)
CSS (97 vs 55%)
Tamaki
54
47
CSS (85/83%)
Nemoto
141
28
EBRT 50-60 Gy, #HDR 8-12 Gy in 2-6 fractions, #LDR 12 Gy in 3 fractions
3-year OS (90% in T1a) (70% in T1b)
CSS (cancer specific survival), # prescription dose at a depth of 5 mm from the surface of the oesophageal mucosa
Table 27.2 B: External beam radiotherapy (EBRT) with and without chemotherapy (CHT) and endoluminal brachytherapy (BT) – curative indications in inoperable OC.
Study
Patients (N)
Follow-up (months)
Procedure (BT type; doses)
Endpoint (at n years)
Upfront brachytherapy boost followed by external beam Vuong 70 26
HDR boost prior EBRT+CHT (5 x 4 Gy HDR at 0.5 cm from the mucosa plus 50 Gy) HDR boost prior EBRT+CHT (2 x 5 Gy at 0.7 cm from the mucosa plus 50,4 Gy) HDR boost prior EBRT+CHT (3 x 8 Gy plus 50 Gy at 5 mm mucosal depth) EBRT+CHT plus HDR boost (60 Gy plus 1 x 7 or 2 x 5 Gy at 1 cm from source with a 12 mm applicator) EBRT+CHT plus HDR boost (60 Gy plus 2 x 5 Gy HDR at 5 mm mucosal depth) EBRT+CHT 60 Gy plus boost (BT 2 x 5 Gy at 5 mm mucosal depth vs. 10 Gy EBRT) EBRT 60 Gy plus BT boost (HDR 2x5 Gy vs. LDR 3x3 Gy at 5 mm mucosal depth) EBRT 50 Gy + BT + CHT (HDR 3x5 Gy vs. LDR 20 Gy at 10 mm from applicator center with outer diameter of 4-6 mm)
2-Y LC (75%)
Safaei
20
3
ORR (100%)
Patonay
61
12
1Y AD (90%)
External beam first followed by brachytherapy boost Tessa 75
2/5-Y LC (35/33%)
Calais (phase II study)
53
39
3/5-Y SR (27/18%)
Okawa (phase III study)
94
48
5-Y CSS, STL (64 vs 31.5%)
Ishikawa
38
5-Y CSS, STL (85.7 vs 55.6%)
Gaspar (phase I/II study))
49
1-Y OS (49%, high toxicity)
LC (Local control), ORR (overall response rate), AD (alleviation dysphagia), SR (survival rate), CSS (cancer specific survival), STL (short tumour length less than 5 cm),
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