High dose-rate intraluminal brachytherapy for carcinoma of the esophagus

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Abstract
To determine the effectiveness and toxicity of high dose-rate intraluminal brachytherapy as a component of treatment on local control and palliation in patients with esophageal cancer. From 1980 to 1991, 47 evaluable patients received high dose-rate intraluminal brachytherapy as a component of treatment for esophageal cancer. They were divided into three treatment groups: Group A – 21 patients treated for primary, non-metastatic disease; Group B – 14 patients with recurrent, non-metastatic disease, and Group C – 12 patients with metastatic disease. Twelve of 21 (57%) Group A patients had a complete response at the end of treatment and eight (38%) remained locally controlled at last follow-up. The median survival was 11 months and two-year actuarial survival was 27%. For Group B, local control rates were 64% at completion of treatment and 36% at last follow-up. Median survival was six months. Only 2/12 (17%) of Group C patients were locally controlled and median survival was 5.5 months. For the total patient group, severe (Grades 3–4) complications were seen in 17/47 (36%) patients. Fistulae occurred in 8/47 (17%) patients: 4.5 (80%) patients receiving multiple courses of brachytherapy compared to 4/42 (9.5%) patients treated with a single course. P = 0.002. Our data suggest that the use of high dose-rate intraluminal brachytherapy as a component of treatment in esophageal cancer is a reasonable approach. The results of ongoing clinical trials will help determine the role of high dose-rate intraluminal brachytherapy in the multimodal management of esophageal cancer.

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