2007 年 38 巻 2+3 号 p. 69-74
Purpose: We reviewed the treatment outcome of 41 early-stage esophageal cancer (34 mucosa layer cases, 7 sub mucosa stage cases) for three treatment methods focusing on the effectiveness of brachytherapy for cases treated from January 1991 to December 2005.
Materials and Methods: The age of the patients ranged from 38 to 84 years old (median age 68 years) with 37 male patients and 4 female patients. The treatment methods reviewed were (1) External beam radiation therapy (EBRT) group: 5 cases, 60∼66 Gy (one case radiotherapy only, 3 cases with chemotherapy and 1 case with endoscopic therapy). (2) High dose rate remote after load system (RALS) endoesophageal brachyterapy group (BT) group: 9 cases (3 cases radiotherapy only, none case with chemotherapy, 6 cases with endoscopic therapy). Irradiation was 6∼20 Gy in 2 to 3 fractions. (3) Combined external beam radiation therapy and brachytherapy (EBRT + BT) group: 27 cases, after external beam radiation of 30∼66 Gy, patients were treated with 12∼18 Gy in 2 or 3 fractions by brachytherapy (17 cases radiotherapy only, 8 cases with chemotherapy, 2 cases with endoscopic therapy).
Results: There was not a significant difference in the cumulative survival rate between the BT and EBRT + BT groups. Sixteen cases of local recurrence or lymph node metastasis were observed for the 41 cases (39.0%) with a median time of 95 months (3∼186 months). Complications occurred for 12 of 41 cases (29.2%) with a median time of 20 months (3∼62 months) after the end of treatment. (Complication symptoms included mucosal ulceration, severe esophagitis, esophageal perforation, stenosis, fibrosis of mediastinal space and esophago-bronchial fistula.
Conclusions: For early stage esophageal cancer, external beam radiotherapy of about 60 Gy followed by brachytherapy appears to reduce both recurrence rate and complication rate.
