COMBINED EXTERNAL-BEAM AND LOW-DOSE RATE INTRALUMINAL RADIOTHERAPY INESOPHAGEAL CANCER

Thirty-five patients with oesophageal cancer were treated with externa l beam irradiation (50-60 Gy) followed by a boost-dose of 15-20 Gy by means of low dose rate intraluminal brachytherapy. Of the 35 patients treated 17 (48%) were pretreated with laser therapy or dilation alone. Although the intraluminal application time was long (up to 36 h) the treatment was feasable with minor acute toxicity. The palliative effec t of the combined treatment was excellent; at 6 weeks post-treatment 3 2 of the 35 patients were able to eat solid food. Late complications w ere seen in six patients (17%), of which only one was severe and proba bly treatment-related. The median survival was 11 months; the 1- and 2 -year survival were 42% and 10% respectively. The survival was strongl y dependant on local control. Distant metastases became evident in 23% of patients. The interval between external radiotherapy and brachythe rapy seemed to be critical. The results were compared with 68 historic al controls. A significantly better survival was observed at 6 months. It is concluded that low dose rate intraluminal brachytherapy is a us eful and feasable technique to increase the total dose for obtaining a better local control. The shortcomings are discussed and ideas for fu rther improvement are mentioned.