- San Francisco
- Edward Susman
- Gastrointestinal Cancer Symposium
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
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
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
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
OCF Note: We have included this article as cancers of the digestive tract are frequent sites for metastasis or recurrence of oral cancers.