External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma

Abstract

PurposeTo assess the effectiveness of definitive radiation therapy in patients with potentially curable esophageal cancer and to evaluate the side-effects of this treatment. Methods and materialsSixty-two patients with esophageal cancer, who were treated with definitive, curatively intended radiotherapy consisting of external radiotherapy (60Gy in 30 fractions), preceded and followed by LDR or HDR intraluminal brachy (12Gy in 2 fractions) were retrospectively analyzed. ResultsRecurrences were reported in 38 patients (61%), of which 25 (64%) failed locally first.The overall survival rates at 1, 2 and 5years were 57%, 34% and 11%, respectively. The median overall survival was 15months. No prognostic factors could be identified. Most frequently reported treatment related toxicities were esophagitis, ulcerations, (11%) and strictures (16%). In 10 patients (16%) severe toxicities, were reported including grade III ulceration (2 cases), stricture (1 case), radiation pneumonitis (1 case), perforation (1 case), esophageal-pleural-tracheal fistula (1 case), and acute esophageal bleeding (4 cases). A history of gastrectomy was significantly associated with the development of severe toxicity. ConclusionCuratively intended radiotherapy alone can be offered to esophageal cancer patients, even when surgery and/or chemotherapy are not feasible. However, we observed severe toxicity in a substantial part of the patients. Given the relatively high rate of severe complications and the uncertainties regarding dose escalation, the addition of brachytherapy, with consequently high surface doses, should be limited to well-selected patients.