High-dose-rate intraluminal brachytherapy prior to external radiochemotherapy in locally advanced esophageal cancer: preliminary results

Abstract

PurposeDysphagia is a common initial presentation in locally advanced esophageal cancer and negatively impacts patient quality of life and treatment compliance. To induce fast relief of dysphagia in patients with potentially operable esophageal cancer high-dose-rate (HDR) brachytherapy was applied prior to definitive radiochemotherapy.Material and methodsIn this single arm phase II clinical trial between 2013 to 2014 twenty patients with locally advanced esophageal cancer (17 squamous cell and 3 adenocarcinoma) were treated with upfront 10 Gy HDR brachytherapy, followed by 50.4 Gy external beam radiotherapy (EBRT) and concurrent chemotherapy with cisplatin/5-fluorouracil.ResultsTumor response, as measured by endoscopy and/or computed tomography scan, revealed complete remission in 16 and partial response in 4 patients (overall response rate 100%). Improvement of dysphagia was induced by brachytherapy within a few days and maintained up to the end of treatment in 80% of patients. No differences in either response rate or dysphagia resolution were found between squamous cell and adenocarcinoma histology. The grade 2 and 3 acute pancytopenia or bicytopenia reported in 4 patients, while sub-acute adverse effects with painful ulceration was seen in five patients, occurring after a median of 2 months. A perforation developed in one patient during the procedure of brachytherapy that resolved successfully with immediate surgery.ConclusionsBrachytherapy before EBRT was a safe and effective procedure to induce rapid and durable relief from dysphagia, especially when combined with EBRT.

Chemoradiotherapy Combined with Brachytherapy for the Definitive Treatment of Esophageal Carcinoma

“…Our findings of improved LC are corroborated by other trials incorporating BT in definitive treatment concepts for esophageal cancer, most of which are discussed in two recent large review publications [11,12]. Several retrospective series have investigated the addition of brachytherapy for superficial tumors [13][14][15][16][17][18][19][20][21], as well as locally advanced tumors with [22][23][24][25][26][27] or without chemotherapy [28][29][30][31][32][33][34]. The addition of brachytherapy to CRT in the RTOG 9207 study led to an improvement in patients achieving complete remission in comparison to patients treated with CRT alone (RTOG 8501 study): from 68% to 74%.…”

Esophageal cancer

“…38 Intraluminal brachytherapy, a form of radiotherapy, applies a stent over the lesion to provide rapid relief from dysphagia with an additional radioactive source. 54 This treatment, although rarely used, has proven long-term benefits, especially for patients with unresectable esophageal cancer. 38 Ablative therapy, more useful after resection and for patients with Barrett esophagus, also can provide some relief but is associated with the need for more sessions compared with stent placement.…”

“…Self-expanding metal stents can be placed endoscopically over esophageal lesions, generally without the need for dilation, and can provide rapid relief 38. Intraluminal brachytherapy, a form of radiotherapy, applies a stent over the lesion to provide rapid relief from dysphagia with an additional radioactive source 54. This treatment, although rarely used, has proven long-term benefits, especially for patients with unresectable esophageal cancer 38.…”

Comparative study of concomitant chemoradiation versus concomitant chemoradiation followed by high-dose-rate intraluminal brachytherapy in locally advanced esophageal carcinoma: a single institutional study

“…Definitive chemoradiotherapy treatment is usually reserved for patients with extensive locoregional esophageal carcinoma that is not resectable, or for patients who are not suitable candidates for surgery because of medical risk [ 4 ]. Brachytherapy, as compared to external beam radiation therapy (EBRT), offers rapid tumor reduction of intraluminal portion of the tumor, thus rapidly restoring the swallowing function and at the same time, delivers relatively low-dose to the surrounding normal tissues particularly lung, spinal cord, and adjacent normal esophageal mucosa [ 5 ].…”