High-dose-rate brachytherapy boost following concurrent chemoradiotherapy for esophageal carcinoma

Purpose: To assess the efficacy, toxicity, and the optimum dose of high-dos e-rate brachytherapy following chemoradiotherapy (CRT) compared with a hist orical group of patients treated with a combination of external beam and br achytherapy (RT alone). Methods and Materials: Fifty-three patients with localized esophageal cance r received concurrent chemoradiotherapy followed by brachytherapy. The chem otherapy regimen was a combination of cisplatin 60 mg/m(2) on day 1 and flu orouracil 600 mg/m(2) continuous infusion from days 1-4 during the first an d last week of external irradiation. Radiotherapy consisted of external irr adiation to a total dose of 40-61 Gy (median 50 Gy) and brachytherapy to 8- 24 Gy (median 16 Gy) in 2-4 fractions. Results: Acute toxicity was well tolerated. A fistula occurred in one patie nt 1 week after completion of external irradiation. Local control was achie ved in 32/53 (60%) compared with 42% of the RT group (p = 0.029). Local con trol rates of the CRT group were significantly better than those of the RT group in Stages II and III. Late toxicity (esophageal ulceration and strict ures) occurred in 18 (34%) of the CRT group compared with 12% in the RT gro up (p = 0.013). Severe late toxicity (RTOG/EORTC criteria Grade 3-4) occurr ed in six patients (15%) whose chemotherapy was followed by 16-24 Gy via br achytherapy compared with 2.5% in the RT group (p = 0.010). Conclusion: Combined chemoradiotherapy and brachytherapy boost achieved bet ter local control than radiotherapy alone. However, a high level of severe late toxicity was observed especially with 16-24 Gy via brachytherapy, (C) 1999 Elsevier Science Inc.