식도암의 관내 근접 방사선 치료

Abstract

Purpose : To evaluate efficacy of intraluminal irradiation and external beam radiation in locally advanced esophageal cancer. Methods and Materials : Ninteen patients who were treated with intraluminal irradiation for locally advanced esophageal cancer between January 1989 and October 1993 at the Department of Radiation Oncology, Keimyung University Hospital were included in this study. There were 17 males and 2 females with median age of 60.5 years (range 47-82 years). According to American Joint Committee on Cancer(AJCC) staging system, there were 5(26.3%) patients in stage Ⅱa, 14(73.7%) patients in stage Ⅲ and the pathologic classification showed 17 patients of squamous cell carcinoma. External beam radiation dose were 5400-6660 cGs for 6-7.5weeks at primary tumor bed, mediastinum and locoregional lymphatic system. Intraluminal irradiation with 192Ir were applicated to 8 patients by high dose rate and 11 patients by low dose rate at 1cm from esophageal mucosal surface(450-1500cGy/1-3fr). Neoadjuvant chemotherapy with CDDP(100mg/m2, D1) and 5-FU(1g/m2, D1-D5) every 4weeks interval were admitted to 12 patients for 1 -3 cycles, All patients were followed up for 6-135 months (median 11 months, mean 25 months), The survival rates were calculated by actuarial methods and the statistical signifcance of survival was analysed by the log-rank test. Results : Local control rate was 42.1%(8/19), median survival was 11 months and 1-year, 2-year and 5-year survival rates were 39.9%, 11.4% and 11.4% respectively. The survival difference according to age and local control were statistically significant (p＜0.05). Local control was the most significant prognostic factor (median survival: 17months for positive local control and 7 months for negative local control, p=.0000). Dose rate was not statistically significant but high dose rate was more longer median survival than low dose rate (13months, 8months, p=0.13). Neoadjuvant chemotherapy was not significant but less median survival time than no neoadjuvant chemotherapy (10months, 17months). Complications included mild esophagitis In four patients, moderate esophagitis in one patient and mild esophageal stenosis in three patients. Conclusion : We considered that the intraluminal irradiation for locally advanced esophageal cancer patients was well tolerated and increase of locoregional control rate may result in longer survival and better quality of life.