Combined brachytherapy and external beam radiation: an effective approach for palliation in esophageal cancer

Abstract

PurposePalliation of dysphagia is a challenge in advanced esophageal cancer. The addition of external beam radiotherapy (EBRT) to intraluminal brachytherapy (ILBT) has shown significant improvement in dysphagia relief and symptom scores. The aim of the present study was to evaluate the efficacy of combined use of ILBT and EBRT.Material and methodsThe medical records of 148 patients with advanced/metastatic esophageal cancer were screened from January 2008 to April 2014, and 74 patients were found eligible for the analysis. All patients received two fractions of 8 Gy each of ILBT, followed by EBRT. Patients were assessed for the symptom scores of dysphagia, odynophagia, regurgitation, and chest pain and weight was recorded periodically.ResultsFor a median follow-up of 6 months, the median OS was 9.5 months (95% CI: 7.5-10.5). The median dysphagia free survival was 6 months (95% CI: 4.8-7.1). The scores for dysphagia significantly improved after completion of 1st ILBT (p = 0.000), 2nd ILBT (p = 0.000), and at 3 months after EBRT compared to ILBT (p = 0.02). Overall 47% had improvement in dysphagia scores and 35% maintained the improvement of scores till last follow up. There was significant improvement in weight after completion of ILBT (p = 0.001) and at 3 months after completion of EBRT (p = 0.00). Twenty nine (39%) patients required nasogastric (NGT) insertions and 12 (16%) needed hospitalization for supportive care. 36.4% had complications in the form of stricture (27%), fistula (5.4%), and bleeding (4%).ConclusionsPalliative radiotherapy is an effective alternative for palliation of dysphagia with improvement in symptom scores being evident and sustained. The results of this clinical audit were comparable with those from the trial setting.

Effectiveness of several external beam radiotherapy schedules for palliation of esophageal cancer

“…Treatment options used for the palliation of dysphagia include local interventions such as stent placement [4], intraluminal brachytherapy (ILBT) [4], [5], [6], external beam radiotherapy (EBRT) [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], and systemic treatment with chemotherapy, or even, combined chemoradiation [18], [19]. A randomised trial [4] compared stent placement with ILBT for the treatment of incurable esophageal cancer.…”

Current status of brachytherapy in cancer treatment – short overview

“…Endoesophageal brachytherapy makes it possible to use high doses of radiation to the tumor itself with concurrent protection of the adjoining healthy tissues due to the rapid fall in the dose, with the square of the distance from the center of the dose. The above treatment also leads to a smaller proportion of late radiation complications [ 70 , 71 ].…”

Clinical implementation of a novel applicator in high-dose-rate brachytherapy treatment of esophageal cancer

“…The authors concluded that dose escalation with larger diameter applicators may allow for improved therapeutic coverage without exceeding the organs at risk tolerances [ 23 ]. The latest research in the combined approach (EBRT and HDR) to palliation in esophageal cancer together with the review of the current techniques is reported in [ 25 , 26 ].…”