Brachytherapy in the Management of Esophageal Cancer: A Single Institution Experience

Abstract

Esophageal brachytherapy has been shown to be effective in palliating dysphagia. This treatment enables delivery of a high dose of radiation therapy (RT) to the tumor whereas dose is limited to nearby organs, which allow its use in salvage after a prior external beam RT. Despite known efficacy and available guidelines, brachytherapy remains underutilized. This study evaluates the practice of brachytherapy, symptomatic response to this treatment, and observed toxicities at a single center. A literature review was carried out to identify and review the articles related to brachytherapy in management of esophageal cancer. A retrospective chart review was conducted after identifying 28 patients who received esophageal brachytherapy at our center from 2009-2017. A review of medical records provided information about their diagnosis, management, and follow-up. Descriptive statistics were utilized along with Kaplan and Meier method for time to event variables. The usual brachytherapy dose was 18 Gy in 3 fractions over 1-2 weeks and the external beam RT dose used was 50 Gy in 25 fractions over 5 weeks. Mellow and Pinkas dysphagia scoring system was used to assess swallowing. Most (71.4%) patients were male. Approximately two thirds of patients had an adenocarcinoma located in the lower thoracic esophagus. Majority (68%) received brachytherapy for persistent dysphagia with a palliative intent. Eight (29%) patients received brachytherapy after developing a local failure post curative intent treatment for salvage. One patient received curative intent brachytherapy in combination with EBRT. A majority (56%) of patients had an improvement in swallowing following brachytherapy. The median dysphagia free survival after intraluminal brachytherapy was 13.6 weeks (CI 5.2-21.9). A proportion of patients did not respond where reasons were multifactorial. The observed complication rate was favorable. Only 2 (7%) patients developed strictures requiring dilatation and 3 (10.6%) had bleeding that was controlled. There were no esophageal perforations, development of tracheoesophageal fistulas or mortality associated with brachytherapy. Two patients were lost to follow up. Of the remaining 26 patients, 4 (15.4%) are alive and 22 (84.6%) have died. Literature review supports the use of this modality. Esophageal brachytherapy was fairly well tolerated with an improvement in swallowing by at least one point for most patients. There were no major adverse events. It remains an effective treatment among cases where options are limited such as a local recurrence after an initial curative intent therapy, as well as for relief of dysphagia in a palliative setting. This review found esophageal brachytherapy as an effective and safe management modality. There is a need of an increase in the use of intraluminal brachytherapy and an exposure of radiation oncology trainees to gain technical expertise in its administration.