High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer : Experience from a large single-center cohort.

Abstract

The aim of this work was to evaluate outcomes and toxicities of high dose-rate (HDR) endoluminal brachytherapy in acohort of esophageal cancer patients. We analyzed the records of 36patients treated with HDR brachytherapy for histologically confirmed esophageal cancer. Brachytherapy was either applied as aboost treatment for definitive treatment regimens or as salvage therapy for recurrent tumors with single doses between 4and 6Gy. Survival and toxicities were retrospectively analyzed. Brachytherapy was performed as initially planned in all but one patient; 18patients had acomplete endoscopic response at the first follow-up examination. Locoregional recurrence was observed in 24patients after amedian time of 3months; 1‑ and 2‑year recurrence-free survival rates were 51and 51 % for the patients treated for primary tumors and 11and 6 % for patients treated for tumor recurrence, respectively. Median overall survival was 18months; estimated overall survival rates at1, 2,and 3years were 63, 50,and 30 % after primary brachytherapy, and 60, 25,and 6 % after recurrence therapy. Adenocarcinoma histology, non-complete remission after treatment, and treatment for recurrent cancers were associated with significantly reduced prognoses. Mild dysphagia was the most common side effect in 17patients; 8patients suffered from locoregional grade3 toxicities, and no grade4 or5 toxicities were observed. Endoluminal brachytherapy during the course of esophageal cancer treatment can be safely applied and results in good functional outcomes regarding dysphagia with low rates of severe toxicities.