Esophageal brachytherapy: Institut Gustave Roussy's experience

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Esophageal cancer often exhibits local progression, significantly impacting patient prognosis and quality of life.
• Brachytherapy presents a potential therapeutic avenue across various stages of esophageal cancer.

Purpose of the Study:

• To evaluate the efficacy and toxicity of high-dose-rate brachytherapy in esophageal cancer patients.
• To identify factors influencing survival outcomes in patients treated with esophageal brachytherapy.

Main Methods:

• A retrospective, single-institution study of 90 consecutive patients treated with high-dose-rate esophageal brachytherapy between 1992 and 2018.
• Patients received brachytherapy as exclusive treatment, boost, reirradiation, or for palliative care.
• Treatment schemes included 3x5 Gy or 6x5 Gy, with dose prescription at the applicator's surface or 5 mm.

Main Results:

• Local recurrence occurred in 50% of patients, and 17% experienced metastatic relapse.
• Median overall survival was 15 months, with variations based on treatment indication (e.g., 25 months for exclusive treatment, 2 months for palliative).
• Tumor length, brachytherapy dose, and interfraction response were significant survival predictors. Grade 2+ toxicity, mainly esophagitis, affected 40% of patients, including three toxic deaths.

Conclusions:

• Despite poor local control, esophageal brachytherapy is a viable option for patients unfit for curative therapies, offering better outcomes than palliative chemotherapy.
• Reirradiation with brachytherapy is a promising indication due to its dose gradient and organ-at-risk sparing capabilities.
• Further investigation into esophageal brachytherapy is warranted, as it can benefit select patients, including the unfit, with acceptable toxicity profiles.