Palliation of advanced/recurrent esophageal carcinoma with high-dose-rate brachytherapy.
OBJECTIVE
The aim was to assess the improvement in swallowing status, complication rate, and overall survival.


METHODS
Fifty-eight patients with advanced/recurrent esophageal carcinoma were treated for palliation with high-dose-rate intraluminal brachytherapy (HDR-ILRT) with a remote afterloading microSelectron unit (192Ir source) with or without external radiation from November 1994 to May 2000 at the Tata Memorial Hospital. The mean age was 64 years. The mid-third of the esophagus was involved in 38 patients (66%). The group was comprised of 37 previously untreated patients (29 with < or = 50% Karnofsky performance status and old age, 4 with metastatic disease, and 4 with second primary esophageal lesions) and 21 patients with post-treatment recurrent tumors. Thirty-eight patients (65%) received intraluminal brachytherapy alone, whereas the remaining 20 patients (35%) received a combination of external and intraluminal radiation therapy. All patients received 2 fractions of HDR-ILRT 1 week apart with 600 cGy per fraction at 1 cm off axis.


RESULTS
Overall improvement in swallowing status was seen in 22 patients (48%), and 24 (41%) maintained pretreatment swallowing status. Median dysphagia-free survival was 10 months. Overall complication rates were 30%, with stricture seen in 9 patients (15%), ulceration in 6 (10%), and tracheo-esophageal fistula in 3 patients (5%). Complication rates were higher in the post-treatment group (38%) than in the previously untreated group (27%) (p = 0.29). The median overall survival for the entire group was 7 months. Median survival was better, although not significantly, for the previously untreated cohort: 7.8 months vs. 6 months for the post-treatment group (p = 0.77).


CONCLUSIONS
HDR-ILRT brachytherapy achieves good palliation with acceptable complications in advanced/recurrent esophageal carcinoma.
Sharma
Vinay
V
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. sharmavinay@vsnl.net
Mahantshetty
Umesh
U
Dinshaw
Ketayun A
KA
Deshpande
Raman
R
Sharma
Sanjay
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003679:Deglutition; D003680:Deglutition Disorders / Q000532:radiotherapy*; D004935:Esophageal Diseases / Q000209:etiology; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004940:Esophageal Stenosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods*; D015996:Survival Rate; D014138:Tracheoesophageal Fistula / Q000209:etiology; D014456:Ulcer / Q000209:etiology