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S. Dutta

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    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P1.07-015 - Dysphagia palliation in locally advanced carcinoma esophagus: Role of Intraluminal brachytherapy. (ID 1308)

      09:30 - 16:30  |  Author(s): S. Dutta

      • Abstract

      About 60-70 % patients present with advanced disease in carcinoma oesophagus with limited curative option. There are high local recurrence rate of 32%-45% when treated with surgery alone and 77% when radiation therapy only. So, the results of the treatment of ca oesophagus have been poor inspite of advances in various treatment modalities. A high tumour dose is needed to achieve adequate local control, which is possible by an intraluminal boost following teletherapy. The advantage of intraluminal brachytherapy as a means of dose escalation following EBRT based on inverse square law and quick dose fall off which results in relative sparing of surrounding normal tissues, and potentially improving the therapeutic ratio. Dysphagia is a potential problem. Brachytherapy is effective in palliation of dysphagia by delivering high tumoricidal dose may achieve excellent local control rate and disease free survival with acceptable toxicities.

      Total of 40 atients with histologically proven carcinoma, tumour ≤ 5 cm in length, KPS > 50 with no prior malignancy or N0 status and unfit for surgery were taken in to the study. Intraluminal high dose rate (HDR) brachytherapy treatment was performed with the remote after loading HDR microselecton unit which contained a single cylindrical high-activity 192Ir source. Dose fractionation used 15 Gy in 3 # at 1 week interval. The prescription point was 0.5 cm from mucosal surface from the mid source. The improvement in dysphagia free scores, patterns of failure and treatment related toxicities were assessed. After treatment all patients were followed up with UGIE, barium swallow and chest X-ray at 2 months.

      Out of 40 cases analyzed, the lesion was present in mid 1/3[rd] in 18 patients, upper 1/3[rd] in 12 and involving GE junction in 10 cases. The median length of treatment was 5 cm. Gr II dyspahagia was in 34% and Gr III in 66% patients were seen. After treatment 40% of patients had improvement in dyspahgia. Stricture was found in 4 patients, ulceration in 7 and bleeding in 3 and 2 patient had trachea-esophageal fistula. Eight patients lost to follow up. Patients who had Gr II dysphagia initially had no progression in the complain. The median overall survival is 12.1 months and the median PFS was 18 months. who had initially Gr II dysphagia had no progression of dysphagia.

      With dose fractionation of 5 Gy / # for 3 # and CT based planning enabled good optimisation along with decreased risk of high dose to mucosa by using 6 Fr tube, this schedule has shown effective palliation in dysphagia and few complication rates and comparable survival benefits. However a larger number of cases and a longer follow up is required.