ABSTRACT
PURPOSE
Despite advancements in the early detection of esophageal cancer, optimal radiotherapy
methods for treatment of early disease have not yet been determined. Moreover, the
benefit of intraluminal brachytherapy on local control or survival remains controversial.
We performed a systematic review to establish the role of brachytherapy as boost therapy
in stage I esophageal squamous cell carcinoma, and to evaluate associated survival
outcomes.
METHODS AND MATERIALS
A systematic search of three bibliographic databases from January 1950 to January
2019 was conducted. All studies investigating brachytherapy for curative intent were
included and palliative treatment was excluded. Primary outcomes included overall
survival and disease-free survival (DFS). Secondary outcomes included loco-regional
control (LRC) and toxicity grades and/or complications. Two reviewers independently
abstracted data and evaluated study quality using grading of recommendations assessment,
development, and evaluation, pooled results were presented through risk ratios.
RESULTS
A total of 12 retrospective studies met inclusion criteria. The overall quality of
evidence yielded a Grade 1C rating (strong recommendation, low quality evidence).
Of 525 included patients, 325 patients received both external beam radiation (EBRT),
and brachytherapy, 132 underwent EBRT only, and 68 received brachytherapy with and/or
without chemoradiation. For patient group treated with EBRT and brachytherapy, 5-year
mortality, DFS and LRC were: 43% (27–59%), 63% (49–76%) and 72% (63–80%) respectively.
Rates of complications reported included 82.1% Grade 1 esophagitis for a combined
external beam radiation and brachytherapy cohort, 12.3% ulcerations, and 3.3% fistulae.
CONCLUSIONS
Brachytherapy as a combined modality is encouraging, given its relative safety and
effectiveness. Further prospective analysis using higher quality evidence is warranted
to evaluate oncologic outcomes and survival advantage.
Keywords
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Article Info
Publication History
Published online: August 05, 2022
Accepted:
May 30,
2022
Received in revised form:
April 25,
2022
Received:
January 6,
2022
Publication stage
In Press Corrected ProofFootnotes
Disclosures: All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of American Brachytherapy Society.
