Fractionated high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer.
Fractionated high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer.
复制标题
分次高剂量率腔内近距离放射治疗对晚期食管癌的姑息治疗。
DOI：
10.1016/s0360-3016(97)00710-4
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
A. Mannell
中科院分区：
文献类型：
--
作者：
R. Sur;B. Donde;V. Levin;A. Mannell
结果22例患者因病情较重、一般情况较差等原因在完成治疗前死亡。全组12个月总生存率为19.4%（A组9.8%，B组22.46%，C组35.32%; P> 0.05）。全组12个月无吞咽困难生存率为28.9%（A组10.8%，B组25.43%，C组38.95%; p> 0.05）。43例患者出现需要扩张的纤维化狭窄（A--35例中的5例，B--60例中的15例，C--55例中的23例; p= 0.032）。27例患者有持续性管腔疾病（A-11，B-6，C-10），其中15例进展为瘘（A-7，B-2，C-6; p= 0.032）。年龄、性别、种族、组织学、体能状态、既往扩张、吞咽困难评分、体重、分级、肿瘤长度和分期对总生存率、无吞咽困难和无并发症生存率无影响（p> 0.05）。在多变量分析中，发现近距离放射治疗剂量（p= 0.002）和肿瘤长度（p= 0.0209）对总生存期有显著影响;近距离放射治疗剂量是影响局部肿瘤控制的唯一因素（p= 0.0005），而肿瘤长度是影响无吞咽困难生存期的唯一因素（p= 0.0475）。当比较其他形式的姑息治疗目前可用（搭桥手术，激光，化疗，插管，外部放疗），分割近距离放射治疗的中位生存期为6.2 months.ConclusionsFractionated近距离放射治疗是最好的结果姑息晚期食管癌的最佳方式。与目前可用的所有其他方式相比，它为患者提供了最佳的缓解。最佳近距离放射治疗剂量范围为16戈伊分两次和18戈伊分三次，间隔一周。
ResultsTwenty-two patients died before completing treatment due to advanced disease and poor general condition. The overall survival was 19.4% at the end of 12 months for the whole group (A--9.8%, B--22.46%, C--35.32%; p> 0.05). The dysphagia-free survival was 28.9% at 12 months for the whole group (A--10.8%, B--25.43%, C--38.95%; p> 0.05). Forty-three patients developed fibrotic strictures needing dilatation (A--5 of 35, B--15 of 60, C--23 of 55; p= 0.032). Twenty-seven patients had persistent luminal disease (A--11, B--6, C--10), 15 of which progressed to fistulae (A--7, B--2, C--6; p= 0.032). There was no effect of age, sex, race, histology, performance status, previous dilation, presenting dysphagia score, presenting weight, grade, tumor length, and stage on overall survival, dysphagia-free, and complication-free survival (p> 0.05). On a multivariate analysis, brachytherapy dose (p= 0.002) and tumor length (p= 0.0209) were found to have a significant effect on overall survival; brachytherapy dose was the only factor that had an impact on local tumor control (p= 0.0005), while tumor length was the only factor that had an effect on dysphagia-free survival (p= 0.0475). When compared to other forms of palliation currently available (bypass surgery, laser, chemotherapy, intubation, external radiotherapy), fractionated brachytherapy gave the best results with a median survival of 6.2 months.ConclusionsFractionated brachytherapy is the best modality for palliation of advanced esophageal cancer. It offers the best palliation to patient when compared to all other modalities currently available. The optimal brachytherapy dose ranges between 16 Gy in two fractions and 18 Gy in three fractions given a week apart.