Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients

Michael R. Folkert, Gil'ad N. Cohen, Abraham J. Wu, Hans Gerdes, Mark A. Schattner, Arnold J. Markowitz, Emmy Ludwig, David H. Ilson, Manjit S. Bains, Michael J. Zelefsky, Karyn A. Goodman

Research output: Contribution to journalArticle

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Abstract

Purpose: The management of superficial primary and recurrent esophageal cancer (EC) in medically inoperable patients is complex. Endoluminal high-dose-rate (HDR) brachytherapy has shown mixed results in terms of toxicity and local control. In this study, we examined the outcomes and toxicities in a set of patients with superficial primary and recurrent EC treated with a consistent HDR technique. Methods and Materials: Between 8/2008 and 7/2011, 14 patients were treated with HDR intraluminal brachytherapy, 10 (71.4%) with recurrent disease, and 4 (28.6%) with previously unirradiated lesions. Patients received three weekly fractions to a median dose of 12 Gy (range, 10-15 Gy); dose was prescribed to 7-mm median depth with mucosal dose limited to 8-10 Gy using a 12-14-mm applicator. Results: Median followup was 15.4 months. Overall freedom from failure (OFFF) and overall survival (OS) at 18 months were 30.8% (95% confidence interval [CI]: 5.2, 56.4) and 72.7% (95% CI: 45.3, 100), respectively. For patients with recurrent disease, OFFF and OS at 18 months were 11.1% (95% CI: 0, 32.1) and 55.6% (95% CI: 15.4, 95.8), respectively. For patients with previously unirradiated disease, OFFF and OS at 18 months were 75.0% (95% CI: 31.6, 100) and 100.0%, respectively. Eight (57.1%) patients had Grade 1 acute adverse effects; 6 (42.9%) patients had chronic Grade 1 adverse effects; 1 (7.1%) patient developed Grade 2 stricture. Grade 3 tracheoesophageal fistula occurred in 1 (7.1%) patient. One patient died before completion of treatment of unrelated causes. Conclusions: HDR endoluminal brachytherapy is a well-tolerated treatment for superficial primary and recurrent EC in medically inoperable patients.

Original languageEnglish (US)
Pages (from-to)463-470
Number of pages8
JournalBrachytherapy
Volume12
Issue number5
DOIs
StatePublished - Sep 2013

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Brachytherapy
Esophageal Neoplasms
Confidence Intervals
Survival
Tracheoesophageal Fistula
Pathologic Constriction

Keywords

  • Brachytherapy
  • Endoluminal
  • Esophageal
  • HDR
  • Medically inoperable
  • Recurrent cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients. / Folkert, Michael R.; Cohen, Gil'ad N.; Wu, Abraham J.; Gerdes, Hans; Schattner, Mark A.; Markowitz, Arnold J.; Ludwig, Emmy; Ilson, David H.; Bains, Manjit S.; Zelefsky, Michael J.; Goodman, Karyn A.

In: Brachytherapy, Vol. 12, No. 5, 09.2013, p. 463-470.

Research output: Contribution to journalArticle

Folkert, MR, Cohen, GN, Wu, AJ, Gerdes, H, Schattner, MA, Markowitz, AJ, Ludwig, E, Ilson, DH, Bains, MS, Zelefsky, MJ & Goodman, KA 2013, 'Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients', Brachytherapy, vol. 12, no. 5, pp. 463-470. https://doi.org/10.1016/j.brachy.2012.12.001
Folkert, Michael R. ; Cohen, Gil'ad N. ; Wu, Abraham J. ; Gerdes, Hans ; Schattner, Mark A. ; Markowitz, Arnold J. ; Ludwig, Emmy ; Ilson, David H. ; Bains, Manjit S. ; Zelefsky, Michael J. ; Goodman, Karyn A. / Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients. In: Brachytherapy. 2013 ; Vol. 12, No. 5. pp. 463-470.
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abstract = "Purpose: The management of superficial primary and recurrent esophageal cancer (EC) in medically inoperable patients is complex. Endoluminal high-dose-rate (HDR) brachytherapy has shown mixed results in terms of toxicity and local control. In this study, we examined the outcomes and toxicities in a set of patients with superficial primary and recurrent EC treated with a consistent HDR technique. Methods and Materials: Between 8/2008 and 7/2011, 14 patients were treated with HDR intraluminal brachytherapy, 10 (71.4{\%}) with recurrent disease, and 4 (28.6{\%}) with previously unirradiated lesions. Patients received three weekly fractions to a median dose of 12 Gy (range, 10-15 Gy); dose was prescribed to 7-mm median depth with mucosal dose limited to 8-10 Gy using a 12-14-mm applicator. Results: Median followup was 15.4 months. Overall freedom from failure (OFFF) and overall survival (OS) at 18 months were 30.8{\%} (95{\%} confidence interval [CI]: 5.2, 56.4) and 72.7{\%} (95{\%} CI: 45.3, 100), respectively. For patients with recurrent disease, OFFF and OS at 18 months were 11.1{\%} (95{\%} CI: 0, 32.1) and 55.6{\%} (95{\%} CI: 15.4, 95.8), respectively. For patients with previously unirradiated disease, OFFF and OS at 18 months were 75.0{\%} (95{\%} CI: 31.6, 100) and 100.0{\%}, respectively. Eight (57.1{\%}) patients had Grade 1 acute adverse effects; 6 (42.9{\%}) patients had chronic Grade 1 adverse effects; 1 (7.1{\%}) patient developed Grade 2 stricture. Grade 3 tracheoesophageal fistula occurred in 1 (7.1{\%}) patient. One patient died before completion of treatment of unrelated causes. Conclusions: HDR endoluminal brachytherapy is a well-tolerated treatment for superficial primary and recurrent EC in medically inoperable patients.",
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AU - Folkert, Michael R.

AU - Cohen, Gil'ad N.

AU - Wu, Abraham J.

AU - Gerdes, Hans

AU - Schattner, Mark A.

AU - Markowitz, Arnold J.

AU - Ludwig, Emmy

AU - Ilson, David H.

AU - Bains, Manjit S.

AU - Zelefsky, Michael J.

AU - Goodman, Karyn A.

PY - 2013/9

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N2 - Purpose: The management of superficial primary and recurrent esophageal cancer (EC) in medically inoperable patients is complex. Endoluminal high-dose-rate (HDR) brachytherapy has shown mixed results in terms of toxicity and local control. In this study, we examined the outcomes and toxicities in a set of patients with superficial primary and recurrent EC treated with a consistent HDR technique. Methods and Materials: Between 8/2008 and 7/2011, 14 patients were treated with HDR intraluminal brachytherapy, 10 (71.4%) with recurrent disease, and 4 (28.6%) with previously unirradiated lesions. Patients received three weekly fractions to a median dose of 12 Gy (range, 10-15 Gy); dose was prescribed to 7-mm median depth with mucosal dose limited to 8-10 Gy using a 12-14-mm applicator. Results: Median followup was 15.4 months. Overall freedom from failure (OFFF) and overall survival (OS) at 18 months were 30.8% (95% confidence interval [CI]: 5.2, 56.4) and 72.7% (95% CI: 45.3, 100), respectively. For patients with recurrent disease, OFFF and OS at 18 months were 11.1% (95% CI: 0, 32.1) and 55.6% (95% CI: 15.4, 95.8), respectively. For patients with previously unirradiated disease, OFFF and OS at 18 months were 75.0% (95% CI: 31.6, 100) and 100.0%, respectively. Eight (57.1%) patients had Grade 1 acute adverse effects; 6 (42.9%) patients had chronic Grade 1 adverse effects; 1 (7.1%) patient developed Grade 2 stricture. Grade 3 tracheoesophageal fistula occurred in 1 (7.1%) patient. One patient died before completion of treatment of unrelated causes. Conclusions: HDR endoluminal brachytherapy is a well-tolerated treatment for superficial primary and recurrent EC in medically inoperable patients.

AB - Purpose: The management of superficial primary and recurrent esophageal cancer (EC) in medically inoperable patients is complex. Endoluminal high-dose-rate (HDR) brachytherapy has shown mixed results in terms of toxicity and local control. In this study, we examined the outcomes and toxicities in a set of patients with superficial primary and recurrent EC treated with a consistent HDR technique. Methods and Materials: Between 8/2008 and 7/2011, 14 patients were treated with HDR intraluminal brachytherapy, 10 (71.4%) with recurrent disease, and 4 (28.6%) with previously unirradiated lesions. Patients received three weekly fractions to a median dose of 12 Gy (range, 10-15 Gy); dose was prescribed to 7-mm median depth with mucosal dose limited to 8-10 Gy using a 12-14-mm applicator. Results: Median followup was 15.4 months. Overall freedom from failure (OFFF) and overall survival (OS) at 18 months were 30.8% (95% confidence interval [CI]: 5.2, 56.4) and 72.7% (95% CI: 45.3, 100), respectively. For patients with recurrent disease, OFFF and OS at 18 months were 11.1% (95% CI: 0, 32.1) and 55.6% (95% CI: 15.4, 95.8), respectively. For patients with previously unirradiated disease, OFFF and OS at 18 months were 75.0% (95% CI: 31.6, 100) and 100.0%, respectively. Eight (57.1%) patients had Grade 1 acute adverse effects; 6 (42.9%) patients had chronic Grade 1 adverse effects; 1 (7.1%) patient developed Grade 2 stricture. Grade 3 tracheoesophageal fistula occurred in 1 (7.1%) patient. One patient died before completion of treatment of unrelated causes. Conclusions: HDR endoluminal brachytherapy is a well-tolerated treatment for superficial primary and recurrent EC in medically inoperable patients.

KW - Brachytherapy

KW - Endoluminal

KW - Esophageal

KW - HDR

KW - Medically inoperable

KW - Recurrent cancer

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