식도암 치료에 있어 관내근접치료의 역할

Abstract

Purpose: To evaluate our clinical experience with the combination of teletherapy and intraluminal brachytherapy in patients with unresectable or inoperable esophageal cancers.

Materials and Methods: From Nov. 1989 to Mar. 1993, twenty patients with esophageal cancer were treated with radical radiotherapy and intraluminal brachytherapy at Yonsei Cancer Center. All patients had squamous histology and stage distribution was as follows: stage II, 4(20%) patients; III, 15(75%) patients; IV, 1(5%) patients. A dose of 5-12 Gy/1-3 weeks with intraluminal brachytherapy (3-5 Gy/fraction) to 5mm from the outside of the esophageal tube using high dose rate iridium-192 reotely afterloading bracytherapy machine was given 2 weeks after a total dose of 59-64Gy with external radiotherapy. Induction chemotherapy using cisplatin and 5-FU was performed in 13 patients with median 3 cycles(1-6 cycles). Response rate, local control rate, survival and complications were analysed retrospectively.

Results: Two-year overall survival rate and median survival were 15.8% and 13.5 months. Resonse rates were as follows: complete remission(CR) 5(25%); partial remission a(Pra) 7(35%); partial remission b(PRb) 7(35%); no response(NR) 1(5%). Patterns of failure were as follows : local failure 13(65%), local and distant failure 3(15%), distant failure 0(0%). Ultimate local control rate was 20%. Treatment related complications included esophageal ulcer in two patients and esophageal stricture in one.

Conclusion: Though poor local control rate, median survival was improved as compared with previous results of radiation therapy alone(8months) and chemo-radiation combined treatment(11months) in Yonsei Cancer Center. High-dose-rate intraluminal brachytherapy following external irradiation is an effective treatment modality with acceptable toxicity in esophageal cancer.