Daytime pulsed dose rate brachytherapy as a new treatment option for previously irradiated patients with recurrent oesophageal cancer

The aim of this study was to evaluate the feasibility, effects, and toxicity of pulsed dose rate (PDR) brachytherapy for re-irradiation of oesophageal carcinoma. A total of 16 patients (median age 67 years) with inoperable recurrences from oesophageal cancer after primary radio-(chemo)-therapy (medi...

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Bibliographic Details
Published in:British journal of radiology 2005-03, Vol.78 (927), p.236-241
Main Authors: HARMS, W, KREMPIEN, R, GREHN, C, BERNS, C, HENSLEY, F. W, DEBUS, J
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Brachytherapy - adverse effects
Brachytherapy - methods
Catheterization - methods
Deglutition Disorders - etiology
Deglutition Disorders - radiotherapy
Disease-Free Survival
Esophageal Neoplasms - complications
Esophageal Neoplasms - radiotherapy
Esophagus
Feasibility Studies
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - radiotherapy
Other diseases. Semiology
Radiotherapy Dosage
Treatment Outcome
Tumors
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Summary:The aim of this study was to evaluate the feasibility, effects, and toxicity of pulsed dose rate (PDR) brachytherapy for re-irradiation of oesophageal carcinoma. A total of 16 patients (median age 67 years) with inoperable recurrences from oesophageal cancer after primary radio-(chemo)-therapy (median 50 Gy) were re-irradiated using PDR brachytherapy ((192)Ir, 37 GBq). Treatment was carried out on an outpatient basis applying a weekly 5 Gy daytime schedule (0.5 Gy pulse(-1) h(-1), total dose 15-20 Gy). The dose was prescribed 10 mm from the mid-dwell position and encompassed the clipped tumour extension with 2 cm margins. The use of clips for delineation of tumour extent and catheter movement during irradiations was evaluated. All 61 PDR treatments were applied safely. The median catheter movement was 5 mm, range 2-12 mm. After a median follow-up of 8 months, three patients had a complete and five a partial remission. Body weight increased in 5 of 16 (31%) and was stable in 4 of 16 (25%) patients, respectively. The median grade 2 (RTOG/EORTC) dysphagia-free survival was 17 months. Seven patients experienced grade 1, five grade 2, and one grade 3 late toxicity. Three patients with uncontrolled locoregional disease showed grade 4 complications (oesophago-tracheal fistulae (n=2), fatal arterial bleeding (n=1). Daytime PDR brachytherapy proved to be feasible and provided effective palliation. Toxicity remains a major problem. Thus, total dose should be restricted to
ISSN:0007-1285
1748-880X
DOI:10.1259/bjr/51982166