title: Salvage high-dose-rate brachytherapy for esophageal cancer in previously irradiated patients: A retrospective analysis.
abstract: OBJECTIVE
  To evaluate outcomes after exclusive salvage high-dose-rate (HDR) intraluminal esophageal brachytherapy given to previously irradiated patients with recurrent esophageal cancer.
  
  
  METHODS
  We reviewed medical records of 30 patients who were treated by salvage HDR brachytherapy for local esophageal cancer. Brachytherapy delivered four to six fractions of 5-7 Gy at 5 mm from the applicator surface and 20 mm above and below the macroscopic tumor volume.
  
  
  RESULTS
  Eighty percentage of patients received treatment as initially planned. Complete response rate, evaluated 1 month after brachytherapy by endoscopy and biopsy, was 53%. Squamous histology and complete endoscopic tumor response at 1 month were significantly associated with better local tumor control. Median local progression-free survival was 9.8 months. Overall survival was 31.5% and 17.5% at 1 and 2 years, respectively. On univariate analysis, preserved performance status and limited weight loss (<10%) before salvage brachytherapy were associated with better overall survival. Severe toxicity (Grade ≥3) occurred in 7 patients (23%).
  
  
  CONCLUSIONS
  Although esophageal cancer in previously irradiated patients is associated with poor outcomes, HDR brachytherapy may be a valuable salvage treatment for inoperable patients with locally limited esophageal cancer, particularly in the subset of patients with preserved performance status and limited weight loss (≤10%) before salvage brachytherapy.
authors.affiliation: Radiation Oncology Department, Saint Louis Hospital, Paris, France; Radiation Oncology Department, Institut du Cancer de Montpellier, Montpellier, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Wong Hee Kam
authors.affiliation: Radiation Oncology Department, Saint Louis Hospital, Paris, France; Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
authors.forename: Sofia
authors.initials: S
authors.lastname: Rivera
authors.affiliation: Radiation Oncology Department, Saint Louis Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hennequin
authors.affiliation: Gastroenterology Department, Saint Louis Hospital, Paris, France.
authors.forename: Nelson
authors.initials: N
authors.lastname: Lourenço
authors.affiliation: General Surgery Department, Saint Louis Hospital, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.affiliation: General Surgery Department, Saint Louis Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.affiliation: Gastroenterology Department, Saint Louis Hospital, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Radiation Oncology Department, Saint Louis Hospital, Paris, France. Electronic address: laurent.quero@sls.aphp.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Quéro
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Brachytherapy; Cancer; Esophageal; High-dose rate; Salvage