Palliation of advanced/recurrent carcinoma esophagus with intraluminal brachytherapy

Introduction: Esophageal Cancers are usually associated with late presentation, advanced disease and poor prognosis. In majority the main objective of treatment remains palliation of dysphagia. In this paper we present the results of patients with advanced or recurrent oesophageal cancers treated with palliative intraluminal brachytherapy. Materials and Methods: Between 1988 to May 2000, 126 patients with advanced / recurrent esophageal carcinomas were treated with intraluminal brachytherapy either low dose rate / medium dose rate (LDR/MDR) since 1988 or high dose rate (HDR) since 1994, with or without external radiation for palliation at the Tata Memorial Hospital. The selection criteria for palliative brachytherapy includes 1) lesions in upper / mid / lower esophagus 2) more than 5 cm long lesion on barium swallow and esophagoscopy 3) histologically proven esophageal carcinoma 4) Karnofsky performance status (KPS) of ≤ 50% 5) Recurrent / metastatic disease. 6) Intraluminal Brachytherapy (ILRT) feasible. Results: There were 68 patients (36 previously untreated, 32 with post -treatment recurrent disease) in LDR/MDR group and 58 patients (37 previously untreated, 21 with post - treatment recurrent disease) in HDR group. Overall improvement in swallowing status was seen in 18 (26. 5%) patients in LDR/MDR group whereas in HDR group, 22 (48%) patients showed improvement in swallowing status and 24 (41%) patients maintained pre-treatment swallowing status. Median dysphagia free survival was 7. 7 months in LDR/MDR and 10 months in HDR group respectively. Post-RT Complication rates were as follows stricture seen in 17%, ulceration in 17% and T. O fistula in 12% patients in LDR/MDR group as compared to 15%, 10% and 5% in HDR group respectively. Complication rates were higher in post-treatment group in both the dose rate groups. Incidence of Post-RT stricture was more with HDR in post-RT recurrent tumors. The median overall survival for the LDR/MDR group was 9. 9 months and 7 months in HDR group. Conclusion: Fractionated intraluminal brachytherapy with either low/medium dose rate or high dose rate offers quick and useful palliation for a prolonged period. Overall complication rates are within acceptable limits. However, the incidence of higher complications especially in post treatment recurrent group (post - RT) remains a major concern and low/medium dose rate should be used for this group. © 2003 IJTCVS.