Combined external and intraluminal radiotherapy in the treatment of advanced oesophageal cancer

Abstract

Background and purpose: Oesophageal cancer still has a dismal prognosis. Radical surgery is by far the most successful treatment but most patients are not operable at the time of diagnosis and for these patients external beam radiotherapy with or without concurrent chemotherapy offers the best choice for cure or palliation. In patients with advanced oesophageal cancer, intraluminal brachytherapy has been proposed as a complementary method to increase local control. Patients and methods: Between 1989 and 1999, 40 patients with inoperable oesophageal cancer were treated with combined external and intraluminal radiation therapy in Turku University Central Hospital. The external radiation was performed with a median total dose of 40 Gy given in 20 fractions. On the average a week after the external radiation a median total dose of 10 Gy intraluminal radiation therapy was given in 4 fractions. Results: The intraluminal brachytherapy could be performed without technical difficulties and no major complications were seen. In many cases (16 out of 40 patients, 40%), the symptoms could be relieved immediately and in most cases the progression of the disease could be delayed as evidenced by post-treatment serial endoscopy. No major complications were encountered. The 1- and 2-year survival rates were 30 and 17.5%, respectively. All patients alive at 2 years can be considered as long-term survivors. Median follow-up was 86 months. Conclusions: Intraluminal brachytherapy is a safe and efficient treatment modality which offers a potential means of cure for selected patients with oesophageal cancer.