title: Effectiveness of Two High-dose-rate Intraluminal Brachytherapy Schedules for Symptom Palliation in Carcinoma Esophagus: A Tertiary Care Center Experience.
abstract: OBJECTIVE
  The aim was to analyze different radiation schedules with high-dose-rate (HDR) brachytherapy in patients with unresectable carcinoma esophagus in terms of dysphagia-free survival (DyFS), local control (LC), disease-free survival (DFS), and complications.
  
  
  METHODS
  Eighty-six patients were studied under three different radiation schedules: Schedule A - radiation 35 Gy/15# followed by HDR brachytherapy 6 Gy each in two sessions; schedule B - chemoradiation 35 Gy/15# with weekly injection cisplatin 30 mg/m(2) infusion and 5-fluorouracil 325 mg/m(2) bolus followed by HDR brachytherapy 6 Gy each in two sessions; and schedule C - same chemoradiation dose followed by HDR brachytherapy three sessions of 4.68 Gy each. The median follow-up was 12.1 months.
  
  
  RESULTS
  Treatment compliance was good. There were no significant differences in the incidence of acute toxicities across the three schedules. No grade III toxicities were noted. At 1 month, 27 patients had dysphagia improvement, which was not different across the three schedules. At 6 months, schedule C showed a trend toward better symptom control of dysphagia (dysphagia free=55%). The 2-year DyFS reached 49.5% in schedule C. Two-year LC rates were approximating 89% in both chemoradiation schedules versus 67.6% in schedule A. The 2-year DFS was also high in chemoradiation schedules. Major complications like ulceration and tracheoesophageal fistulas were more often seen with schedule B with a higher dose per fraction of the brachytherapy schedule.
  
  
  CONCLUSIONS
  In unresectable carcinoma esophagus, radiation-only schedules are associated with lower LC and DFS rates. Concurrent chemoradiation followed by a brachytherapy boost is feasible in suitable patients with a good Karnofsky performance score and are associated with higher DyFS, LC, and DFS with acceptable toxicities. Still there is a need for the standardization of HDR brachytherapy schedules with chemoradiation protocols.
authors: Department of Radiotherapy, PGIMER, Chandigarh, Punjab, India.
authors: Rakesh
authors: R
authors: Kapoor
authors: Anshuma
authors: A
authors: Bansal
authors: Rakesh
authors: R
authors: Kochhar
authors: Pankaj
authors: P
authors: Kumar
authors: Suresh C
authors: SC
authors: Sharma