AMERICAN-BRACHYTHERAPY-SOCIETY (ABS) CONSENSUS GUIDELINES FOR BRACHYTHERAPY OF ESOPHAGEAL CANCER

Introduction: There is wide variation in the indications, treatment re gimens, and dosimetry for brachytherapy in the treatment of cancer of the esophagus. No guidelines for optimal therapy currently exist. Meth ods and Materials: Utilizing published reports and clinical experience , representatives of the Clinical Research Committee of the American B rachytherapy Society (ABS) formulated guidelines for brachytherapy in esophageal cancer. Results: Recommendations were made for brachytherap y in the definitive and palliative treatment of esophageal cancer. (A) Definitive treatment: Good candidates for brachytherapy include patie nts with unifocal thoracic adeno- or squamous cancers less than or equ al to 10 cm in length, with no evidence of intra-abdominal or metastat ic disease. Contraindications include tracheal or bronchial involvemen t, cervical esophagus location, or stenosis that cannot be bypassed. T he esophageal brachytherapy applicator should have an external diamete r of 6-10 mm. If 5FU-based chemotherapy and 45-50-Gy external beam are used, recommended brachytherapy is either: (i) HDR 10 Gy in two weekl y fractions of 5 Gy each; or (ii) LDR 20 Gy in a single course at 0.4- 1 Gy/hr. All doses are specified 1 cm from the midsource or middwell p osition. Brachytherapy should follow external beam radiation therapy a nd should not be given concurrently with chemotherapy. (B) Palliative treatment: Patients with adeno-or squamous cancers of the thoracic eso phagus with distant metastases or unresectable local disease progressi on/recurrence after definitive radiation treatment should be considere d for brachytherapy with palliative intent. After limited dose (30 Gy) EBRT, the recommended brachytherapy is either: (i) HDR 10-14 Gy in on e or two fractions; or (ii) LDR 20-25 Gy in a single course at 0.4-1 G y/hr. The need for external beam radiation in newly diagnosed patients with a life expectancy of less than 3 months is controversial. In the se cases, HDR of 15-20 Gy in two to four fractions or LDR of 25-40 Gy at 0.4-1 Gy/hr may be of benefit. Conclusion: AES guidelines for esoph ageal brachytherapy now exist and will be updated by the ABS in the fu ture, as clinical. data using more uniform treatment techniques become s available. (C) 1997 Elsevier Science Inc.