Late esophageal toxicity using a combination of external beam radiation, intraluminal brachytherapy and 5-fluorouracil infusion in carcinoma of the esophagus

Sharma, Vinay; Agarwal, Jai Prakash; Dinshaw, Ketayun A.; Nehru, R.M; Mohandas, M.; Deshpande, Ramakant; Rayabhattnavar, S.

doi:10.1046/j.1442-2050.2000.00115.x

Cited by 18 publications

(5 citation statements)

References 34 publications

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“…The present study showed survival benefits from the addition of NBT to EBRT and concurrent chemotherapy in the treatment of locally advanced disease that resulted in short-term effects, and these findings are similar to those in the reports of Montravadl et al [ 15 ] and Sharma et al [ 16 ]. This treatment strategy resulted in better long-term survival and local control as other authors have reported [ 14 - 16 ]. The primary reason for these effects is that the incidence of late, severe complications was reduced significantly by this treatment strategy.…”

Section: Discussionsupporting

confidence: 92%

A retrospective study of external beam radiation, neutron brachytherapy, and concurrent chemotherapy for patients with localized advanced carcinoma of the esophagus

Wang

et al. 2014

Radiat Oncol

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PurposeThe aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of a total of 140 esophageal cancer patients who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) and concurrent chemotherapy (CCT).Methods and materialsFrom January 2002 to November 2012, 140 patients with esophageal cancer underwent NBT in combination with EBRT and CCT. The distribution of the patient numbers over the various cancer stages of IIA, IIB, and III were 43, 7, and 90, respectively. The total radiation dose to the reference point via NBT was 8–25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50–60 Gy, which was delivered over a period of five to six weeks with normal fractionation. Fifty-four and 86 patients received tegafur suppositories (TS) and continuous infusion of fluorouracil (5-Fu) with cisplatin (CDDP), respectively.ResultsThe median follow-up time was 42 months. The minimum follow-up was three months, and the maximum was 106 months. The overall median survival including death from all causes was 29.5 months. The five-year overall survival rate (OS) and local control (LC) were 33.4% and 55.9%, respectively. The chemotherapy regimen was a factor that was significantly associated with OS (p = 0.025) according to univariate analysis. The five-year OSs were 27.4% and 44.3% for the PF and TS chemotherapy regimens, respectively. Regarding acute toxicity, no incidences of fistula or massive bleeding were observed during this treatment period. The incidence of severe, late complications was related to the PF chemotherapy regimen (p = 0.080).ConclusionsThe clinical data indicated that NBT in combination with EBRT and CRT produced favorable local control and long-term survival rates for patients with esophageal cancer and that the side effects were tolerable. A reasonable CRT regimen can decrease the rate of severe, late complications.

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Section: Discussionsupporting

confidence: 92%

A retrospective study of external beam radiation, neutron brachytherapy, and concurrent chemotherapy for patients with localized advanced carcinoma of the esophagus

Wang

et al. 2014

Radiat Oncol

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“…However, the direct comparison of these clinical series is hampered by the differences in staging, classification, response end points and duration of follow-up. Table 3 shows that NBT + EBRT with or without CT resulted in treatment complication similar to that which has been reported [17,18,23,25,27]. Because 252 Cf NBT is a form of high-LET radiotherapy, we believe that it is superior to conventional X-ray radiotherapy in treating radio-resistant esophageal cancers.…”

Section: Discussionsupporting

confidence: 70%

“…The risk of late complications seems to be strongly affected by a higher dose and a large fraction size of HDR BT [16,25]. Sharma compared the treatment-related complications in groups 1 (20 Gy BT boost) and 2 (15 Gy BT boost) and reported strictures in 24% vs. 8% (p = 0.029), respectively, ulceration in 30% vs. 28% (p = 0.8), respectively, and tracheoesophageal fistulae in 12% of patients in both groups [25].…”

Section: Discussionmentioning

confidence: 99%

“…Sharma compared the treatment-related complications in groups 1 (20 Gy BT boost) and 2 (15 Gy BT boost) and reported strictures in 24% vs. 8% (p = 0.029), respectively, ulceration in 30% vs. 28% (p = 0.8), respectively, and tracheoesophageal fistulae in 12% of patients in both groups [25]. A high incidence of esophageal fistulas (8%) was reported in the RTOG 9207 study [16].…”

Section: Discussionmentioning

confidence: 99%

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The safety and usefulness of neutron brachytherapy and external beam radiation in the treatment of patients with gastroesophageal junction adenocarcinoma with or without chemotherapy

Wang

Liu

et al. 2014

Radiat Oncol

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PurposeTo assess the safety and usefulness of neutron brachytherapy (NBT) as an adjuvant in the treatment of patients with gastroesophageal junction adenocarcinoma (GEJAC) with external beam radiation (EBRT), with or without chemotherapy.Methods and MaterialsIn total, 197 patients with localized, advanced GEJAC received EBRT and NBT with or without chemotherapy. Radiotherapy consisted of external irradiation to a total dose of 40–54 Gy (median 50 Gy) and brachytherapy to 8–25 Gy (median 20 Gy) in two to five fractions. In total, 88 patients received chemotherapy that consisted of two cycles of a regimen with CDDP and 5FU from days l-4. The cycles were administered on days 1 and 29. MMC was given alone in bolus injection on day 1 each week. The cycles were administered on days 1, 8, 15 and 22.ResultsThe duration of follow-up ranged from six to 106 months (median 30.4 months). The median survival time for the 197 patients was 13.3 months, and the one, two, three- and five-year rates for overall survival were 57.1%, 35.1%, 23.0% and 9.2%, respectively. For acute toxicity, no incidences of fistula and massive bleeding were observed during this treatment period. In total, 159 (80.7%) patients developed Grade 2 hematologic toxicity and 146 (74.1%) patients developed Grade ≥ 2 esophagitis. The median times of incidence of fistula and bleeding were 9.5 (3–27.3) months and 12.7 (5–43.4) months, respectively. The incidence of severe, late complications was related to higher NBT dose/f (20–25 Gy/5 F) and higher total dose(≥70 Gy). In total, 75.2% of the patients resumed normal swallowing and 2.0% had some residual dysphagia (non-malignant) requiring intermittent dilatation.ConclusionA combination of EBRT and NBT with the balloon type applicator was feasible and well tolerated. Better local-regional control and overall survival cannot achieved by a higher dose, and in contrast, a higher dose caused more severe esophageal injury.

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“…[ 14 ] reported no patient developing fistula post-treatment, Sharma et al . [ 24 ] on the other hand reported a 12% incidence of fistula formation and 29% incidence of post-treatment esophageal ulcers. Notably, the patients in this study were administered chemotherapy just prior to ILBT.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of concomitant chemoradiation versus concomitant chemoradiation followed by high-dose-rate intraluminal brachytherapy in locally advanced esophageal carcinoma: a single institutional study

Halder¹,

Biswas²,

Ghosh³

et al. 2018

jcb

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PurposeThe aim of this study is to compare efficacy and toxicity between concurrent chemoradiotherapy (CCRT) followed by high-dose-rate intraluminal brachytherapy (ILBT) and CCRT in inoperable, locally advanced esophageal carcinoma.Material and methodsThirty-four patients with inoperable, locally advanced esophageal carcinoma were randomized into two arms. In the CCRT + ILBT arm (arm A), eighteen patients received 50.4 Gy at 1.8 Gy per fraction over 5.6 weeks, along with concurrent cisplatin (75 mg/m2) intravenously on day 1, and 5-fluorouracil (1000 mg/m2) continuous intravenous infusion on days 1-5, starting on the first day of irradiation and repeated after 28 days. This was followed by ILBT boost with a dose of 10 Gy in 2 fractions, one week apart. In the CCRT arm (arm B), sixteen patients received two cycles of chemotherapy, using the same schedule, along with external beam radiotherapy fractionated in a similar manner without brachytherapy boost. The endpoints were tumor response, acute and late toxicities, disease and progression-free survival.ResultsWith a median follow-up of 13 months, the complete response rate was 88.89% in arm A and 87.50% in arm B (p = 0.71). Acute esophageal toxicity was higher in CCRT followed by ILBT arm (p = 0.60). There was no significant difference between the Kaplan Meier survival plots of disease-free survival (p = 0.68) and progression-free survival (p = 0.55).ConclusionsIn our study, addition of brachytherapy as a boost following concurrent chemoradiation failed to improve treatment outcomes without additional toxicity in locally advanced esophageal cancer.

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Late esophageal toxicity using a combination of external beam radiation, intraluminal brachytherapy and 5-fluorouracil infusion in carcinoma of the esophagus

Cited by 18 publications

References 34 publications

A retrospective study of external beam radiation, neutron brachytherapy, and concurrent chemotherapy for patients with localized advanced carcinoma of the esophagus

A retrospective study of external beam radiation, neutron brachytherapy, and concurrent chemotherapy for patients with localized advanced carcinoma of the esophagus

The safety and usefulness of neutron brachytherapy and external beam radiation in the treatment of patients with gastroesophageal junction adenocarcinoma with or without chemotherapy

Comparative study of concomitant chemoradiation versus concomitant chemoradiation followed by high-dose-rate intraluminal brachytherapy in locally advanced esophageal carcinoma: a single institutional study

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