25 Oesophageal Cancer

Oesophageal Cancer Brachytherapy

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THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 10/06/2019

Table 27.2 A: External beam radiotherapy (EBRT) and endoluminal brachytherapy (BT) – curative indications in superficial oesophageal cancer.

Study

Patients (N)

Follow-up (months)

Procedure (BT type; doses)

Endpoint (at 5 years)

Murakami

87

94

EBRT 54-60 Gy plus #HDR boost(mucosal vs submu- cosal) prescribed brachytherapy dose was 10 Gy (2-4 fractions) or 7.5-15 Gy (3 fractions); in 27 pts. HDR alone 25-36 Gy in 5-18 fractions) EBRT 56-60 Gy plus #BT boost (HDR vs LDR) (3x3 Gy vs 2x5Gy with no difference, p=0.63)

CSS (97 vs 55%)

Tamaki

54

47

CSS (85/83%)

Nemoto

141

28

EBRT 50-60 Gy, #HDR 8-12 Gy in 2-6 fractions, #LDR 12 Gy in 3 fractions

3-year OS (90% in T1a) (70% in T1b)

CSS (cancer specific survival), # prescription dose at a depth of 5 mm from the surface of the oesophageal mucosa

Table 27.2 B: External beam radiotherapy (EBRT) with and without chemotherapy (CHT) and endoluminal brachytherapy (BT) – curative indications in inoperable OC.

Study

Patients (N)

Follow-up (months)

Procedure (BT type; doses)

Endpoint (at n years)

Upfront brachytherapy boost followed by external beam Vuong 70 26

HDR boost prior EBRT+CHT (5 x 4 Gy HDR at 0.5 cm from the mucosa plus 50 Gy) HDR boost prior EBRT+CHT (2 x 5 Gy at 0.7 cm from the mucosa plus 50,4 Gy) HDR boost prior EBRT+CHT (3 x 8 Gy plus 50 Gy at 5 mm mucosal depth) EBRT+CHT plus HDR boost (60 Gy plus 1 x 7 or 2 x 5 Gy at 1 cm from source with a 12 mm applicator) EBRT+CHT plus HDR boost (60 Gy plus 2 x 5 Gy HDR at 5 mm mucosal depth) EBRT+CHT 60 Gy plus boost (BT 2 x 5 Gy at 5 mm mucosal depth vs. 10 Gy EBRT) EBRT 60 Gy plus BT boost (HDR 2x5 Gy vs. LDR 3x3 Gy at 5 mm mucosal depth) EBRT 50 Gy + BT + CHT (HDR 3x5 Gy vs. LDR 20 Gy at 10 mm from applicator center with outer diameter of 4-6 mm)

2-Y LC (75%)

Safaei

20

3

ORR (100%)

Patonay

61

12

1Y AD (90%)

External beam first followed by brachytherapy boost Tessa 75

2/5-Y LC (35/33%)

Calais (phase II study)

53

39

3/5-Y SR (27/18%)

Okawa (phase III study)

94

48

5-Y CSS, STL (64 vs 31.5%)

Ishikawa

38

5-Y CSS, STL (85.7 vs 55.6%)

Gaspar (phase I/II study))

49

1-Y OS (49%, high toxicity)

LC (Local control), ORR (overall response rate), AD (alleviation dysphagia), SR (survival rate), CSS (cancer specific survival), STL (short tumour length less than 5 cm),