Palliative HDR brachytherapy in treatment of advanced esophageal cancer

Abstract

Introduction

Patients not qualified for surgery due to the location and clinically advanced stage of oesophageal cancer constitute a group with poor prognosis. Only few of them qualify for radical teletherapy, most of them are being treated symptomatically. The paper presents preliminary results of HDR brachytherapy applied in patients with inoperable oesophageal cancer.

Material and Methods

Between May 1999 and February 2000, 37 patients with inoperable oesophageal cancer were treated by HDR brachytherapy. The patients’ age ranged between 42 and 81 years, mean: 53.1 yr. In HDR brachytherapy the most commonly employed dose was that of 21.5 Gy (in three fractions) at the tumour site. In four cases the mediastinum was additionally irradiated with a dose of 20 Gy in five fractions, and in nine patients treated radically, teletherapy with a dose of 50–60 Gy at the vicinity of the oesophagus was used following brachytherapy. The effect of the treatment in the form of local remission and regression of dysphagia was assessed in the 1^st, 3^rd and 6^th month of follow-up after the completion of the treatment.

Results

The mean follow-up was 6 months. Total remission, partial remission and no remission, as assessed in the 1st month after the treatment, was found in 7 (18.9%), 18 (48.6%), and 12 (32.4%) patients, respectively. After the 3- and 6-month follow-up remission was re-affirmed in two-thirds of the patients under observation. In the group of patients treated with the combination method total remission was found in two (20%) patients, whereas partial remission was ascertained in 6 (60%) patients. In four (10.8%) patients oesophageal fistula was detected during the follow-up period.

Conclusions

HDR brachytherapy was found to lead to regression of dysfagia in a significant number of patients with inoperable oesophageal cancer. In some patients total remission was achieved lasting more than six months. Tolerance for the treatment was good, and the number of complications did not differ from that reported by other authors.