A single-institutional brachytherapy experience in the management of esophageal cancer

Abstract 

Purpose

The aim of this work was to analyze the efficacy of high-dose-rate brachytherapy in the management of patients with esophageal cancer.

Methods and Materials

Between 2001 and 2008, 104 patients (88 males and 16 females) received a brachytherapy treatment as a part of a personalized multimodal approach. The median age was 72 years, and the median Karnofsky performance status was 60. Brachytherapy was used in different situations: to complete a primary treatment with radical intent in patients not suitable for surgery; to control local recurrences; or to obtain a rapid and durable palliation of dysphagia in patients with metastases or in poor general condition. In selected cases, endoscopic ultrasound images were integrated in treatment planning procedure to obtain a more accurate volume definition. Efficacy in controlling dysphagia was assessed 1 month after brachytherapy.

Results

Fifty-one patients received a radical treatment, and 53 patients were treated to relieve the symptoms. The median overall survival was 20.8 months. Lymph node involvement was found to be a significant prognostic factor for overall survival and dysphagia. Dysphagia was controlled in 88 patients (84.6%), and the median dysphagia-free interval was 17.5 months. Early and late adverse events were generally mild to moderate. The most severe effects were esophagotracheal fistulas, observed in 3 patients.

Conclusions

Brachytherapy has an important role in the management of esophageal cancer with a low rate of complications. endoscopic ultrasound–assisted treatment planning can be useful for a better individualization of curative treatments.

Keywords: Esophageal cancer, Palliation, Brachytherapy, Radiotherapy, Dysphagia