A single session of intraluminal brachytherapy in palliation of oesophageal cancer
A single session of intraluminal brachytherapy in palliation of oesophageal cancer
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DOI：
10.1016/0167-8140(95)01667-8
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发表时间：
1995-12-01
影响因子：
5.7
通讯作者：
deJong, J
中科院分区：
文献类型：
--
作者：
Jager, J;Langendijk, H;deJong, J
1987年9月至1993年9月，88例食道癌患者接受了单次腔内照射，照射剂量为距中心轴1 cm处15Gy.在研究的第一部分使用MDR Cs-137(n=51)，在研究的第二部分使用HDR Ir-192(n=37)。所有患者均认为不能手术。在75例可评价的患者中，有50例(67%)在治疗后4-6周吞咽困难得到改善，其中47%的患者吞咽能力完全恢复，28例(37%)患者在随访期间出现吞咽困难复发。另外的姑息治疗包括14例(19%)植入假体，13例(17%)接受第二疗程的近距离放射治疗，11例(15%)仅接受一次或多次扩张，4例(5%)患者接受激光治疗。发生1例非致命性出血和5例瘘管，均伴有肿瘤。两个没有肿瘤迹象的严重溃疡被注意到，都是通过联合治疗进行治疗的。中位生存期为5.5个月。外生的、非循环的生长模式与更好的反应有关。在多变量分析中，远处转移(p=0.0028)、体重减轻(p=0.0051)和外生生长模式(p=0.0199)与较差的生存相关。目前的数据表明，对于预后不良的不能手术的食道癌患者，单次ILB对于缓解吞咽困难是合适的。到目前为止，还没有明确的证据表明增加ERT的好处。
Between September 1987 and September 1993, 88 patients with oesophageal cancer were treated by a single session of intraluminal brachytherapy of 15 Gy prescribed at 1 cm distance from the central axis, using MDR Cs-137 (n = 51) during the first part of the study and HDR Ir-192 (n = 37) during the second part of the study. All patients were regarded as inoperable. Improvement of dysphagia, assessed 4-6 weeks after treatment, was noted in 50 of 75 (67%) evaluable patients, whereas swallowing ability was completely restored in 47% of them, Relapse of dysphagia occurred in 28 (37%) patients during follow-up. Additional palliative treatment consisted of endoprosthesis in 14 (19%), a second course of brachytherapy in 13 (17%), one or more dilatations only in 11 (15%) and laser treatment in four (5%) patients. One non-fatal haemorrhage and five fistulae occurred, all in the presence of tumour. Two severe ulcerations without evidence of tumour were noted, both managed by combined curative treatment. The median survival of the group investigated was 5.5 months. An exophytic, non-circular growth pattern was associated with a better response. In a multivariate analysis the presence of distant metastases (p = 0.0028), weight loss (p = 0.0051) and an exophytic growth pattern (p = 0.0199) were associated with a worse survival. The present data indicate that a single session of ILB is appropriate in the palliation of dysphagia in patients with inoperable oesophagal cancer showing bad prognostic signs. Up to now there has been no clear evidence for benefit of addition of ERT.