CANCER OF THE ESOPHAGUS - BRACHYTHERAPY, EXTERNAL-BEAM RADIATION AND CHEMOTHERAPY

Background - Locoregional tumor control is a major problem following e xternal beam radiation for cancer of the esophagus. Brachytherapy allo ws the delivery of higher radiation doses, possibly leading to improve d local control and subsequent palliation of dysphagia. Materials and Methods - Forty patients with cancer of the esophagus (21 adenocarcino ma, 17 adenocarcinoma, 1 adenosquamous, 1 undifferentiated) arising ab ove the carina in 9, below the carina in 31, received Ir-192 high dose rate (HDR) esophageal brachytherapy and external beam radiation eithe r for palliation (30 patients) or definitive treatment (10 patients). Fourteen patients received concurrent chemotherapy (Cisplatinum, 5-Flu orouracil). Results - With a minimum follow-up of 6 months, the median survival for the 40 patients was 11 months; 17 months and 9 months fo r radical and palliative treatment, respectively. Dysphagia was improv ed at 1, 3 and 6 months from completion of radiation therapy in 14/36 (39%), 9/23 (39%) and 5/12 (42%) evaluable patients. Weight loss of mo re than 5 lb in the previous 2 months occurred in 12/36 (33%) 1 month from end of radiation; 18/23 (78%) at 3 months. Swallowing was maintai ned until death in 33/40 (82%). Locoregional recurrence or progression following treatment occurred in 87% (26/30) of deceased patients. Con clusions - While palliation of dysphagia can be expected following ext ernal beam and HDREB in 40-50 % of patients for 3-6 months, locoregion al control is still a major problem. HDR esophageal brachytherapy, ext ernal beam radiation and concurrent chemotherapy is recommended for pa tients without systemic metastases. A short course of external beam ra diation combined with HDR esophageal brachytherapy sufficiently pallia tes patients with distant metastases.