High dose rate brachytherapy for superficial cancer of the esophagus

Purpose: We analyzed our experience with external radiotherapy, combined mo dality treatment, or HDR brachytherapy alone to limited esophageal cancers. Methods and Materials: From 1991 to 1996, 25 patients with limited superfic ial esophagus carcinomas were treated by high dose rate brachytherapy. The mean age was 63 years (43-86 years). Five patients showed superficial local recurrence after external radiotherapy. Eleven patients without invasion o f the basal membrane were staged as Tis. Fourteen patients with tumors invo lving the submucosa without spreading to the muscle were staged as T1, Trea tment consisted of HDR brachytherapy alone in 13 patients, external radioth erapy and brachytherapy in 8 cases, and concomitant chemo- and radiotherapy in 4 cases. External beam radiation was administered to a total dose of 50 Gy using 2 Gy daily fractions in 5 weeks. In cases of HDR brachytherapy al one (13 patients), 6 applications were performed once a week. Results: The mean follow-up is 31 months (range 24-96 months). Twelve patie nts received 2 applications and 13 patients received 6 applications. Twelve patients experienced a failure (48%), 11/12 located in the esophagus, all of them in the treated volume. One patient presented an isolated distant me tastasis, In the patients treated for superficial recurrence, 4/5 were loca lly controlled (80%) by brachytherapy alone. After brachytherapy alone, 8/1 3 patients were controlled (61%), The mean disease-free survival is 14 mont hs (1-36 months), Overall survival is 76% at 1 year, 37% at 2 gears, and 14 % at 3 Sears. Overall survival for Tis patients is 24% vs. 20% for T1 (p = 0.83), Overall survival for patients treated by HDR brachytherapy alone is 43%, One patient presented with a fistula with local failure after external radiotherapy and brachytherapy, Four stenosis were registered, two were di agnosed on barium swallowing without symptoms, and two required dilatations , Conclusion: High dose rate brachytherapy permits the treating of patients w ith superficial esophageal cancer with good tolerance. Early tumors, locate d in the mucosa, might be treated by HDR brachytherapy alone or by a combin ed modality treatment in which HDR brachytherapy can take place like a boos t. This approach may cure localized recurrences. (C) 2000 Elsevier Science Inc.