title: Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients.
abstract: OBJECTIVE
  The management of superficial primary and recurrent esophageal cancer (EC) in medically inoperable patients is complex. Endoluminal high-dose-rate (HDR) brachytherapy has shown mixed results in terms of toxicity and local control. In this study, we examined the outcomes and toxicities in a set of patients with superficial primary and recurrent EC treated with a consistent HDR technique.
  
  
  METHODS
  Between 8/2008 and 7/2011, 14 patients were treated with HDR intraluminal brachytherapy, 10 (71.4%) with recurrent disease, and 4 (28.6%) with previously unirradiated lesions. Patients received three weekly fractions to a median dose of 12 Gy (range, 10-15 Gy); dose was prescribed to 7-mm median depth with mucosal dose limited to 8-10 Gy using a 12-14-mm applicator.
  
  
  RESULTS
  Median followup was 15.4 months. Overall freedom from failure (OFFF) and overall survival (OS) at 18 months were 30.8% (95% confidence interval [CI]: 5.2, 56.4) and 72.7% (95% CI: 45.3, 100), respectively. For patients with recurrent disease, OFFF and OS at 18 months were 11.1% (95% CI: 0, 32.1) and 55.6% (95% CI: 15.4, 95.8), respectively. For patients with previously unirradiated disease, OFFF and OS at 18 months were 75.0% (95% CI: 31.6, 100) and 100.0%, respectively. Eight (57.1%) patients had Grade 1 acute adverse effects; 6 (42.9%) patients had chronic Grade 1 adverse effects; 1 (7.1%) patient developed Grade 2 stricture. Grade 3 tracheoesophageal fistula occurred in 1 (7.1%) patient. One patient died before completion of treatment of unrelated causes.
  
  
  CONCLUSIONS
  HDR endoluminal brachytherapy is a well-tolerated treatment for superficial primary and recurrent EC in medically inoperable patients.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Michael R
authors: MR
authors: Folkert
authors: Gil'ad N
authors: GN
authors: Cohen
authors: Abraham J
authors: AJ
authors: Wu
authors: Hans
authors: H
authors: Gerdes
authors: Mark A
authors: MA
authors: Schattner
authors: Arnold J
authors: AJ
authors: Markowitz
authors: Emmy
authors: E
authors: Ludwig
authors: David H
authors: DH
authors: Ilson
authors: Manjit S
authors: MS
authors: Bains
authors: Michael J
authors: MJ
authors: Zelefsky
authors: Karyn A
authors: KA
authors: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011882:Radiotherapy, High-Energy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brachytherapy; Endoluminal; Esophageal; HDR; Medically inoperable; Recurrent cancer