Effective palliation for inoperable esophageal cancer using intensive intracavitary radiation.

In a pilot study between May 1988 and May 1989, ten consecutive patients with advanced esophageal cancer were treated with a short intensive course of intraluminal curietherapy without external beam irradiation at the Kaiser Permanente-Los Angeles Medical Center. Nine of ten patients achieved effective palliation comparable to that of standard external beam teletherapy from other series. Most patients had already failed other palliative modalities including chemotherapy, laser debridement, dilation, and electrocautery. The duration of response was generally longer than with these techniques. All patients completed therapy, and tolerance was excellent. Intraluminal irradiation is an attractive, effectual therapeutic alternative, especially in patients with advanced local or distant disease unlikely to tolerate 5 to 7 weeks of external beam therapy.     

Single fraction per day versus two fractions per day versus radiochemotherapy in the treatment of head and neck cancer

From January 1978 to January 1988, 859 patients with T3-T4, NO-3, MO were randomly allocated to receive either: Group A--60Co 60, 60 Gy in 30 fractions; Group B--60Co, 70.4 Gy in 64 fractions; Group C--60Co, 60 Gy in 30 fractions plus chemotherapy (5 Fu, 250 mg/m2/IV every 2 days). Chemotherapy and radiotherapy were combined simultaneously. The average age was 56 years; the male/female ratio was 802/57. Median performance status (ECOG scale) was 1 (range 0-2). The TNM distribution as UICC criteria was T3 529 patients; T4 330 patients; No 217 patients; N1 52 patients; N2 319 patients; and N3 271 patients. The primary sites were nasopharynx 92, oral cavity 252, hypopharynx 119, larynx 310, and others (sinuses and unknown primary)86. Complete response was achieved in 188/277 patients in Group A (67.8%), 254/282 patients in Group B (90%), and 289/300 in Group C (96.3%). All patients were followed and statistical analysis shows a significant improvement in median duration of response, as well as survival for Groups B and C compared with Group A. No significant differences were seen between Group B and C. The acute toxicity was mucositis, skin toxicity, bone marrow depression. A mean temporary weight loss of 4.9 Kg was observed with a range of 2.3-10.5 Kg.     

External beam radiation therapy followed by high-dose-rate brachytherapy for inoperable superficial esophageal carcinoma

PURPOSE: The aim of this study was to retrospectively evaluate the feasibility, efficacy, and tolerance of external beam radiotherapy followed by high-dose-rate brachytherapy in inoperable patients with superficial esophageal cancer. PATIENTS AND METHODS: From November 1992 to May 1999, 66 patients with superficial esophageal cancer were treated with exclusive radiotherapy. The median age was 60 years (range, 41-85). Fifty-three percent of them were ineligible for surgery owing to synchronous or previously treated head-and-neck cancer. Most of the patients (n = 49) were evaluated with endoscopic ultrasonography (EUS) or computed tomography (CT). The mean doses of external beam radiotherapy and high-dose rate brachytherapy were 57.1 Gy (+/-4.83) and 8.82 Gy (+/-3.98), respectively. The most frequently used regimen was 60 Gy followed by 7 Gy at 5 mm depth in two applications. RESULTS: Among patients evaluated with EUS or CT, the complete response rate was 98%. The 3-, 5-, and 7-year survival rates were 57.9%, 35.6%, and 26.6%, respectively. Median overall survival was 3.8 years. The 5-year relapse-free survival and cause-specific survival were 54.6% and 76.9%. The 5-year overall, relapse-free, and cause-specific survival of the whole population of 66 patients was 33%, 53%, and 77%, respectively. Local failure occurred in 15 of 66 patients; 6 were treated with brachytherapy. Severe late toxicity (mostly esophageal stenosis) rated according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale occurred in 6 of 66 patients (9%). CONCLUSION: This well tolerated regimen may be a therapeutic alternative for inoperable patients with superficial esophageal cancer. Only a randomized study could be able to check the potential benefit of brachytherapy after external beam radiation in superficial esophageal cancer.     

Combined radiotherapy for inoperable esophageal cancer

Among 112 patients with inoperable esophageal cancer treated with high-dose intraluminal brachytherapy and distant irradiation, objective response was in 84.8%. Predominantly local complications were reported in 78.6%. Recurrences were detected in 63.5% during follow-up, with mean relapse-free period being 107 days. Mean survival time was 15.3 months (1-, 2- and 3-year survival--58.8; 22.3 and 12.9%, respectively) which was comparable to similar results of palliative esophagectomy for gastric cancer.     

Postoperative radiation therapy for adenocarcinoma of the cecum using two fractions per day

Twenty-one patients with adenocarcinoma of the cecum received post-operative local and regional radiation therapy, using two fractions per day. Six lesions were too extensive for any attempt at removal, and none of these was controlled by the irradiation. However, there have been no local recurrences among the 15 who had all or most of the local tumor excised. This local control rate is significantly better than that reported for definitive surgery alone.     

41例局部晚期不可手术胰腺癌三维适形或调强放疗的临床分析

目的 分析局部晚期胰腺癌以放疗为主的治疗结果.方法 搜集2007年12月前近8年初治局部晚期胰腺癌临床资料,共1例,均为2002AJCC分期Ⅲ期.采用三维适形或调强放疗,单纯放疗11例,同步放化疗30例.结果 全组中位生存时间和1年总生存率分别为9.2个月和23%.疗前KPS评分≥80、无区域淋巴结转移和放疗后达完全缓解或部分缓解者提示可获得更好生存期,其中位生存时间分别为11.1个月:5.8个月(χ2=7.50,P=0.006)、10.8个月:6.5个月(χ2=5.67,P=0.017)和19.5个月:9.1个月(χ2=7.28,P=0.007).同步化疗的加入较单纯放疗有提高生存的趋势(χ2=3.25,P=0.072).放疗末总临床获益者18例,主要为腹痛缓解17例(41%).无4级血液学毒性及3级非血液学毒性发生.结论 三维适形或调强放疗局部晚期胰腺癌副反应低,可提高临床获益.疗前KPS较高、无区域淋巴结转移和疗后达完全缓解或部分缓解者可望获得较好疗效,加同步化疗有提高生存率趋势.     

食管癌常规分割剂量每周5天与每周7天照射的疗效观察

目的观察和比较常规分割剂量每周照射7天与每周照射5天两种方法治疗Ⅲ期食管癌的疗效及放射反应。方法对96例Ⅲ期食管癌首治病例随机分成每周照射7天组(治疗组)和每周照射5天组(对照组),治疗组48例,2.0Gy次/,1次/天,7天/周,共60~70Gy,30~35分次,30~35天完成;对照组48例,2.0 Gy次/,1次/天,5天/周,共60~70 Gy,30~35分次,40~47天完成。结果治疗组与对照组1、2、3年生存率分别为77.1%、62.5%、50%和66.7%、37.5%、22.9%,治疗组高于对照组(P<0.05)。1、2、3年局控率分别为8 1.3%、6 4.6%、5 4.1%和6 8.7%、41.6%、31.2%,治疗组高于对照组(P<0.05)。急性放射性食管炎发生率分别为10.4%和6.2%,差别无显著意义(P>0.05)。出血穿孔的发生率分别为6.2%和4.3%,差别无显著意义(P>0.05)。结论常规分割剂量7天/周照射比5天/周照射可提高疗效,未明显增加不良反应。     

Clinical application of multiple fractions per day in lung and esophageal cancer

We applied MFD to the treatment of forty-nine patients with lung and esophageal cancer. In lung cancer tumor response, tumor regression rate and local recurrence-free survival rate were higher in the MFD group. Although the actuarial survival rates in the two group were similar, the frequency of radiation pneumonitis was much lower in the MFD group. In esophageal cancer, the actuarial survival rate in the MFD group (49.8%) was significantly higher than that in the control group. (14.6%). However, the late effects of radiation were stricture in the 3.2 Gy/2f/day group. Further studies are needed to establish the optimal dose fractionation and indications for MFD therapy.     

Hypofractionated radiation therapy for inoperable advanced stage non-small cell lung cancer.

AIMS AND BACKGROUND: Inoperable advanced stage lung cancer is usually treated by radiation therapy. Although a minority of patients may achieve prolonged survival with aggressive therapeutic approaches, most patients present with adverse prognostic factors that do not allow curative treatment. For these cases palliation of symptoms becomes the main treatment purpose, and short treatment schedules are commonly employed. METHODS: Fifty-two inoperable patients with stage IIIB or IV non-small cell lung cancer (NSCLC) were treated with a hypofractionated schedule of radiotherapy. Initially all patients received 20 Gy in five fractions, and approximately one month after irradiation completion patients underwent clinical and radiological evaluation. Those that achieved a >50% reduction in tumor load and respiratory symptoms were submitted to a second similar short course of radiotherapy. RESULTS: Thirty-three (63%) patients received only one course of radiotherapy. After the first evaluation, 19 patients (37%), all stage IIIB, fulfilled the criteria to receive a total dose of 40 Gy. Survival rates at one and two years were 33% and 0%, respectively, in the group of patients that received 20 Gy, and 52% and 21% respectively, in the group treated with 40 Gy. Two-year survival rates were 10% for stage IIIB and 0% for stage IV patients. Among the patients that were irradiated with a dose of 20 Gy, a subjective reduction of dyspnea and cough and remission of hemoptysis were observed in 97%, 82% and 80% cases, respectively. Complete remission of dyspnea and coughing was observed in 17 (89%) and 14 (74%) patients treated with two irradiation courses. Only mild toxicity was recorded. CONCLUSIONS: Our treatment schedule achieved symptom control in the majority of patients. Early evaluation after 20 Gy allowed selection of responsive patients that could benefit from more prolonged treatment.     

Necessary radiological items for radiation therapy of esophageal cancer

Necessary items for radiation therapy of an esophageal cancer are discussed in detail. These radiological items can be dissolved through the radiological findings by use of the fine double contrast method of treating the esophagus. One method is to dissolve the infiltrative depth of the esophageal cancer; the other is the radiological diagnostic method to dissolve the effect of the radiation therapy on the esophageal cancer. In fact, regarding the former, the classification of the X-ray type is essential and depends upon the infiltrative depth of the cancer and, for the latter, the radiological findings before and after irradiation must be compared.     

Usefulness of esophageal prosthesis in inoperable esophageal cancer

Radiotherapy of inoperable esophageal cancer provided palliation for dysphagia in only 40% of the patients treated over the past 5 years at our hospital. The remaining patients were unable to eat a regular diet even after radiotherapy and to provide them with nourishment, a gastrostomy and/or IVH were required. We feel that the release of the patient from a medical environment will lead to a better quality of remaining life. From our experience with a prosthesis tube for palliation of a malignant esophageal stricture, 4 patients showed excellent results with this way of improving their oral intake.     

同步放化疗治疗不能手术的食管癌临床结果

目的 探讨同步放化疗治疗不能手术的食管癌的近期疗效、生存期及毒性反应.方法 88例食管癌患者根据入选标准随机分组,43例进入放疗＋化疗组（放化组）,45例进入单纯放疗组（单放组）.化疗为第1～4天氟尿嘧啶500mg/m^2＋顺铂20mg/m^2（DF方案）.放疗从第1天即开始,6MVX线三野等中心照射,DT60～65Gy,30～33分次,6.0～6.5周.结果放化组与单放组完全缓解率分别为32.6%、13%（X^2=4.63,P＜0.05）.1、2、3年局部控制率放化组分别为79%、65%、51%,单放组的分别为69%、49%、42%（X^2=3.12,P=0.056）.1、2、3年生存率放化组分别为77%、58%、47%,单放组的分别为67%、42%、38%（X^2=2.27,P=0.132）.放化组毒性反应大于单放组,但患者均能耐受.结论 以DF方案化疗配合放疗不能手术的食管癌近期疗效和局部控制率较好,有提高远期生存率可能,虽毒性反应增加但能耐受.     

High-dose thoracic radiation therapy at 3.0 Gy/fraction in inoperable stage I/II non-small cell lung cancer

OBJECTIVE: High-dose thoracic radiation therapy (HDTRT) alone has been an alternative to surgery in stage I/II non-small cell lung cancer patients with medical co-morbidities and/or poor performance status. Here, we report on the outcome and safety of HDTRT at 3.0 Gy per fraction for reduced treatment duration. METHODS: HDTRT alone at 3.0 Gy per fraction was given to 35 patients (22 at stage I and 13 at stage II). The median age was 73 years old and 14 patients had ECOG performance above 2. The median radiation dose to the primary lesion was 60 (54-66) Gy over 27 (23-38) days, and the dose to the mediastinum was individualized. RESULTS: After the median follow-up of 24 (3-72) months, local in-field progression developed in 11 patients (31.4%) and distant metastases in 14 (40.0%). The median survival period and the 3- and 5-year overall survival (OS) rates for all patients were 24.0 (95% CI: 13.57-34.43) months, 31.4 and 11.2%. Intercurrent deaths were observed in 11 patients. Treatment-related acute and subacute morbidities were observed in 20 patients (57.1%); however, there was neither treatment interruption nor long-term morbidity. CONCLUSIONS: On the basis of the above observations, we achieved treatment outcomes comparable with those of conventional protracted fractionation schedules at considerably shorter duration and lower cost by HDTRT at 3.0 Gy per fraction.     

Use of stereotactic body radiation therapy for medically inoperable multiple primary lung cancer

Introduction: To review outcomes of medically inoperable patients treated with stereotactic body radiation therapy (SBRT) for multiple primary lung cancer (MPLC). Methods: We retrospectively reviewed the charts of 10 patients (21 lesions) treated with SBRT for synchronous (seven), metachronous (one) or synchronous/metachronous lung cancers. All patients were male, medically inoperable and had a median age of 66 years. Eight patients had bilateral disease and two had unilateral disease. All patients had a histological diagnosis in at least one of the two lesions and four patients (44.4%) had both lesions biopsied. There were 18 T1 lesions and three T2 lesions. SBRT was in three fractions of 20 Gy or five fractions of 11–12 Gy to each lesion. Results: Mean and median follow up were 18.8 and 15.5 months, respectively. At analysis, six patients (60.0%) are alive, and five of these living patients (83.3%) have no evidence of disease recurrence or progression. Four patients (44.4%) developed distant metastatic disease. Twenty lesions (95.2%) achieved in‐field local control. No patients experienced acute pulmonary complications and only two patients (22.2%) experienced late grade I lung toxicity as per the Radiation Therapy Oncology Group toxicity criteria. Conclusion: SBRT for MPLC in medically inoperable patients is a safe, feasible and effective treatment approach.     

Results of radiotherapy for inoperable locally advanced esophageal cancer

Three hundred and eleven patients with locally advanced esophageal cancer were treated by radiation therapy from 1968 to 1983 at Tokyo Women's Medical College. Of these, 288 patients with previously untreated, histologically confirmed squamous cell carcinoma but previously treated with curative intent, were eligible for analysis. The cumulative 5-year survival rate of 288 patients given radical radiotherapy was 9.0%. Sex, tumor length, and Stage (AJC) had a great influence on prognosis. The five-year survival rate in males was 5.4% and in females was 22.4%. The five-year survival rate in cases with a tumor length of 5 cm or less was 17.7% in 5-10 cm was 10.0%, and in 10 cm or above was 2.8% and they were 20.2% for Stage I, 9.9% for Stage II, and 2.6% for Stage III. There were no significant differences of survival rate among age, tumor site, and tumor type on X ray film. This data suggests that comparatively early, small-volume tumors share a significant potential for cure by radiotherapy, but potent combined therapy is necessary for the treatment of advanced cancers.     

Irradiation therapy with multiple small fractions per day in urinary bladder cancer

In a clinical trial 168 patients with carcinoma of the bladder, T2-T4, were randomized to one of two treatments; 1 Gy 3 times a day to a total of 84 Gy or 2 Gy once a day to a total of 64 Gy. Local eradication of the tumour in the bladder cystoscopically and cytologically at 6 months after completion of treatment and patient survival were analyzed. The results favoured significantly the patients treated with 84 Gy. All patients were followed 5-9 years. The survival was significantly improved in patients with T3 lesions treated with 84 Gy (p less than 0.01). Complications in the bowel requiring surgical treatment were not significantly different between the two groups of patients. The results indicate a therapeutic gain by hyperfractionated radiotherapy in comparison to conventional fractionated radiotherapy.     

High-dose radiation therapy for elderly patients with inoperable or unresectable non-small cell lung cancer

PURPOSE: To evaluate definitive radiation therapy delivering doses in excess of 60 Gy for elderly patients aged 75 years or over with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The treatment results for 97 patients aged 75 years or older (mean age 78 years; elderly group) with inoperable or unresectable NSCLC were retrospectively analyzed and compared with those for 206 patients younger than 75 year old (mean age 64 years; younger group). The elderly patients were classified into two groups; 67 patients aged 75-79 years (the elderly A) and 30 patients aged 80 years or older (the elderly B). Most of all patients were treated with a total dose of 60 Gy or more in 2 Gy daily standard fractionation. RESULTS: The overall 2 and 5 year survival rates were 32 and 13% for the elderly A group, and 28 and 4% for the elderly B group, respectively, compared with 36 and 12% for the younger group. There was not a statistically significant difference in survival rates among three groups. In stage I-II NSCLC patients there was also no significant difference in survival curves among the three groups. In patients with stage III disease, however, the survival curve of the elderly B was inferior to those of the younger group and the elderly A group, although the difference was not statistically significant. After the treatment the deterioration rate of the performance status was only 5% in the younger group and 8% in the elderly group. Only three younger and two elderly patients died of late pulmonary insufficiency associated with high-dose irradiation to the proximal bronchus. No other treatment-related event was observed except for mild acceptable acute complications in the elderly groups. CONCLUSIONS: Definitive radiation therapy is recommended to the elderly aged 75 years or older with inoperable or unresectable NSCLC, especially early stage disease, as an acceptable choice of treatment.     

Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy

PURPOSE: To identify clinical and dosimetric factors influencing the risk of pericardial effusion (PCE) in patients with inoperable esophageal cancer treated with definitive concurrent chemotherapy and radiation therapy (RT). METHODS AND MATERIALS: Data for 101 patients with inoperable esophageal cancer treated with concurrent chemotherapy and RT from 2000 to 2003 at our institution were analyzed. The PCE was confirmed from follow-up chest computed tomography scans and radiologic reports, with freedom from PCE computed from the end of RT. Log-rank tests were used to identify clinical and dosimetric factors influencing freedom from PCE. Dosimetric factors were calculated from the dose-volume histogram for the whole heart and pericardium. RESULTS: The crude rate of PCE was 27.7% (28 of 101). Median time to onset of PCE was 5.3 months (range, 1.0-16.7 months) after RT. None of the clinical factors investigated was found to significantly influence the risk of PCE. In univariate analysis, a wide range of dose-volume histogram parameters of the pericardium and heart were associated with risk of PCE, including mean dose to the pericardium, volume of pericardium receiving a dose greater than 3 Gy (V3) to greater than 50 Gy (V50), and heart volume treated to greater than 32-38 Gy. Multivariate analysis selected V30 as the only parameter significantly associated with risk of PCE. CONCLUSIONS: High-dose radiation to the pericardium may strongly increase the risk of PCE. Such a risk may be reduced by minimizing the dose-volume of the irradiated pericardium and heart.