High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer : Experience from a large single-center cohort

Strahlenther Onkol. 2016 Jul;192(7):458-66. doi: 10.1007/s00066-016-0979-7. Epub 2016 May 31.

Abstract

Purpose: The aim of this work was to evaluate outcomes and toxicities of high dose-rate (HDR) endoluminal brachytherapy in a cohort of esophageal cancer patients.

Patients and methods: We analyzed the records of 36 patients treated with HDR brachytherapy for histologically confirmed esophageal cancer. Brachytherapy was either applied as a boost treatment for definitive treatment regimens or as salvage therapy for recurrent tumors with single doses between 4 and 6 Gy. Survival and toxicities were retrospectively analyzed.

Results: Brachytherapy was performed as initially planned in all but one patient; 18 patients had a complete endoscopic response at the first follow-up examination. Locoregional recurrence was observed in 24 patients after a median time of 3 months; 1‑ and 2‑year recurrence-free survival rates were 51 and 51 % for the patients treated for primary tumors and 11 and 6 % for patients treated for tumor recurrence, respectively. Median overall survival was 18 months; estimated overall survival rates at 1, 2, and 3 years were 63, 50, and 30 % after primary brachytherapy, and 60, 25, and 6 % after recurrence therapy. Adenocarcinoma histology, non-complete remission after treatment, and treatment for recurrent cancers were associated with significantly reduced prognoses. Mild dysphagia was the most common side effect in 17 patients; 8 patients suffered from locoregional grade 3 toxicities, and no grade 4 or 5 toxicities were observed.

Conclusions: Endoluminal brachytherapy during the course of esophageal cancer treatment can be safely applied and results in good functional outcomes regarding dysphagia with low rates of severe toxicities.

Keywords: Adverse effects; Dysphagia; Neoplasm recurrence, local; Survival outcome; Toxicity.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / methods
  • Brachytherapy / mortality*
  • Brachytherapy / statistics & numerical data
  • Cohort Studies
  • Disease-Free Survival
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / radiotherapy*
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / radiotherapy*
  • Prevalence
  • Radiation Dose Hypofractionation*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Treatment Outcome