HIGH-DOSE-RATE BRACHYTHERAPY BEFORE EXTERNAL-BEAM IRRADIATION IN INOPERABLE ESOPHAGEAL CANCER

To induce fast relief of dysphagia in patients with oesophageal cancer high dose rate (HDR) brachytherapy was applied before external radiot herapy in a prospective study. Seventy-four patients with inoperable o esophageal cancer (36 squamous cell, 38 adenocarcinoma) were treated w ith a combination of 10 Gy HDR brachytherapy, followed by 40 Gy in 4 w eeks external beam radiotherapy (EBRT), starting 2 weeks later. Tumour response, as measured by endoscopy and/or barium swallow, revealed co mplete remission in 21 and partial response in 38 patients (overall re sponse rate 80%). Improvement of dysphagia was induced by brachytherap y within a few days in 39%, and achieved at the end of treatment in 70 % of patients. Further weight loss was prevented in 39 of the 59 patie nts who presented with weight loss. Pain at presentation improved in 1 2 out of 25 patients. Median survival was 9 months. No differences in either response rate or survival were found in squamous cell or adenoc arcinoma. Side-effects were either acute with minimal discomfort in 32 (42%) or late with painful ulceration in five patients (7%), occurrin g after a median of 4 months. A fistula developed in six patients, all with concurrent tumour. In conclusion, brachytherapy before EBRT was a safe and effective procedure to induce rapid relief of dysphagia, es pecially when combined with EBRT.