title: A single-institutional brachytherapy experience in the management of esophageal cancer.
abstract: OBJECTIVE
  The aim of this work was to analyze the efficacy of high-dose-rate brachytherapy in the management of patients with esophageal cancer.
  
  
  METHODS
  Between 2001 and 2008, 104 patients (88 males and 16 females) received a brachytherapy treatment as a part of a personalized multimodal approach. The median age was 72 years, and the median Karnofsky performance status was 60. Brachytherapy was used in different situations: to complete a primary treatment with radical intent in patients not suitable for surgery; to control local recurrences; or to obtain a rapid and durable palliation of dysphagia in patients with metastases or in poor general condition. In selected cases, endoscopic ultrasound images were integrated in treatment planning procedure to obtain a more accurate volume definition. Efficacy in controlling dysphagia was assessed 1 month after brachytherapy.
  
  
  RESULTS
  Fifty-one patients received a radical treatment, and 53 patients were treated to relieve the symptoms. The median overall survival was 20.8 months. Lymph node involvement was found to be a significant prognostic factor for overall survival and dysphagia. Dysphagia was controlled in 88 patients (84.6%), and the median dysphagia-free interval was 17.5 months. Early and late adverse events were generally mild to moderate. The most severe effects were esophagotracheal fistulas, observed in 3 patients.
  
  
  CONCLUSIONS
  Brachytherapy has an important role in the management of esophageal cancer with a low rate of complications. endoscopic ultrasound-assisted treatment planning can be useful for a better individualization of curative treatments.
authors.affiliation: Radiotherapy Division, Pisa University Hospital, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
authors.forename: Franco
authors.initials: F
authors.lastname: Perrone
authors.forename: Mario
authors.initials: M
authors.lastname: De Liguoro
authors.forename: Marianna
authors.initials: M
authors.lastname: Coppola
authors.forename: Stefano
authors.initials: S
authors.lastname: Santi
authors.forename: Biagio
authors.initials: B
authors.lastname: Solito
authors.forename: Monica
authors.initials: M
authors.lastname: Lencioni
authors.forename: Mauro
authors.initials: M
authors.lastname: Rossi
authors.forename: Luca
authors.initials: L
authors.lastname: Cionini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003680:Deglutition Disorders / Q000209:etiology* / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome