High dose rate brachytherapy for the palliation of malignant dysphagia.
OBJECTIVE
High dose rate (HDR) brachytherapy is a commonly used palliative treatment for esophageal carcinoma. We evaluated the outcome of HDR brachytherapy in patients with malignant dysphagia.


METHODS
A retrospective analysis over a 10-year period was performed of 149 patients treated with HDR brachytherapy, administered in one or two sessions, at a median dose of 15Gy. Patients were evaluated for functional outcome, complications, recurrent dysphagia, and survival.


RESULTS
At 6 weeks after HDR brachytherapy, dysphagia scores had improved from a median of 3 to 2 (n=104; P<0.001), however, dysphagia had not improved in 51 (49%) patients. Procedure-related complications occurred in seven (5%) patients. Late complications, including fistula formation or bleeding, occurred in 11 (7%) patients. Twelve (8%) patients experienced minor retrosternal pain. Median survival of the patients was 160 days with a 1-year survival rate of 15%. Procedure-related mortality was 2%. At follow-up, 55 (37%) patients experienced recurrent dysphagia. In 34 (23%) patients a metal stent was placed to relieve persistent or recurrent dysphagia.


CONCLUSIONS
HDR brachytherapy is a moderately effective treatment for the palliation of malignant dysphagia. The incidence of early major complications is low, however, persistent and recurrent dysphagia occur frequently, and require often additional treatment.
Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center, P.O. Box 2040, Rotterdam 3000 CA, Rotterdam, The Netherlands.
Marjolein Y V
MY
Homs
Wilhelmina M H
WM
Eijkenboom
Véronique L M A
VL
Coen
Jelle
J
Haringsma
Mark
M
van Blankenstein
Ernst J
EJ
Kuipers
Peter D
PD
Siersema
D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care; D012189:Retrospective Studies; D016896:Treatment Outcome