Esophageal cancer patients who are deemed poor surgical candidates may benefit from endoscopically guided brachytherapy, as administered by a team of radiation oncologists and gastroenterologists, according to a Canadian study.
The multidisciplinary approach to treatment resulted in no esophageal perforations in a series of 60 patients, reported Dr. Te Vuong and colleagues at the first Gastrointestinal Cancers Symposium last week in San Francisco.
The meeting was sponsored by the American Society for Therapeutic Radiology and Oncology (ASTRO), the Society of Surgical Oncology (SSO), the American Gastroenterological Association (AGA), and the American Society of Clinical Oncology (ASCO).
According to the poster presentation from the McGill University Health Centre in Montreal, the elderly patients with adenocarcinoma or squamous cell carcinoma of the esophagus were treated with high-dose-rate brachytherapy prior to external-beam radiation therapy. The patients received 20-Gy doses in five fractions, prescribed at 1 cm from the source to the initial tumor bed.
The tumor was identified by direct endoscopy. Radio-oblique clips were placed above and below the tumor at the time of endoscopy for quality control of tumor bed localization. Chemotherapy and/or reduced radiation doses were dependent upon the individual patients' performance status.
"After a median follow-up of 18 months for all 60 patients treated between 1996 and 2003, we saw about a 25% local recurrence rate of the cancer," Vuong said. "Historically we might expect to see a 50% recurrence in these patients, so we believe that we have provided a benefit for them." The median survival was about 19 months, she added.
With regard to complications, there were no perforations or toxic deaths. One patient developed a fistula. In other studies using brachytherapy for esophageal cancer, perforations and fistulas have been reported at a 12% rate, and the toxic death rate at 8%, Vuong noted.
Vuong, who is an associate professor of radiation oncology, stressed that the interdisciplinary approach had much to do with the study’s success.
"(The gastroenterologists) were the people who placed the tubes and I think their expertise allowed us to perform the treatment without suffering any perforations," she told AuntMinnie.com.
The researchers’ choice of using intracavity brachytherapy after external-beam radiation was wise, commented Dr. Harry Bleiberg, director of clinical research in the gastroenterology unit at the Institut Jules Bordet, University of Brussels Cancer Center, Belgium.
"You can kill the tumor with radiation, but too much radiation will also kill the patient. The procedure used by Dr. Vuong and colleagues at McGill is an interesting way of getting more radiation to the tumor while sparing healthy tissue," Bleiberg said. However, he pointed out that few institutions currently have the radiological equipment and expertise to offer this treatment.
Still, "it is a very attractive way to reduce peripheral damage to healthy tissues," commented Dr. Carolyn Compton, Ph.D., the Strathkona professor of pathology at McGill. "Using this method, the doctor can design a dose and deliver radiation that will fit the individual's tumor."
Vuong said that a phase III study to confirm the group's results was in the works.
By Edward SusmanAuntMinnie.com contributing writer
January 27, 2004
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