Intraluminal Radiotherapy
in Esophageal Cancer |
식도암의 관내 근접 방사선 치료 |
김진희; 이호준; 예지원; 최태진; 김옥배 |
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Abstract |
Purpose : To evaluate efficacy
of intraluminal irradiation and external beam radiation in locally advanced esophageal cancer.
Methods and Materials : Ninteen patients who were treated with intraluminal irradiation for locally advanced esophageal cancer between January 1989 and October 1993 at the Department of Radiation Oncology;Keimyung University Hospital were included in this study. There were 17 males and 2 females with median age of 60.5 years (range 47?82 years). According to American Joint Committee on Cancer(AJCC) staging system; there were 5 (26.3%) patients in stage Ha; 14(73.7%) patients in stage III and the pathologic classification showed 17 patients of squamous cell carcinoma. External beam radiation dose were 5400 -6660 cGy for 6-7.5weeks at primary tumor bed; mediastinum and locoregional lymphatic system. Intraluminal irradiation with !92Ir were applicated to 8 patients by high dose rate and 11 patients by low dose rate at lcm from esophageal mucosal surface(450-1500cGy/l-3fr). Neoadjuvant chemotherapy with CDDP(100mg/m2’ DO and 5-FU(lg/m2; D1-d5) every 4 weeks interval were admitted to 12 patients for 1 - 3 cycles. All patients were followed up for 6-135 months (median 11 months; mean 25 months). The survival rates were calculated by actuarial methods and the statistical signifcance of survival was analysed by the log-rank test.
Results : Local control rate was 42.1%(8/19);median survival was 11 months and 1-year; 2-year and 5-year survival rates were 39.9%;11.4% and 11.4% respectively. The survival difference according to age and local control were statistically significant (p<0.05). Local control was the most significant prognostic factor (median survival: 17months for positive local control and 7 months for negative local control; p=.0000). Dose rate was not statistically signifi-cant but high dose rate was more longer median survival than low dose rate (13months; 8months; p=0.13). Neoadjuvant chemotherapy was not significant but less median survival time than no neoadjuvant chemotherapy (1 Omonths; 17months). Complications included mild esophagitis in four patients; moderate esophagitis in one patient and mild esophageal stenosis in three patients.
Conclusion : We considered that the intrakiminal irradiation for locally advanced esophageal cancer patients was well tolerated and increase of locoregional control rate may result in longer survival and better quality of life.
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Key Words:
Esophageal Carcinoma,
Intraluminal Radiotherapy, Survival |
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