Chemoradiotherapy Plus High-dose-rate Intraluminal Brachytherapy Versus Chemoradiotherapy Alone in Locally Advanced...

Esophageal carcinoma is one of the most common causes of cancer-related mortality. It usually presents as locally advanced and metastatic disease with poor prognosis. Dysphagia is the most frequent symptom. This is a retrospective study on seventy two patients of locally advanced esophageal carcinoma who had inoperable disease. The patients were divided into two arms- concurrent chemoradiotherapy (CRT) followed by Intraluminal Brachytherapy (ILBT) or CRT alone. In the CRT + ILBT arm (arm A), thirty-six patients received EBRT 50 Gy in 25 fractions at 2 Gy per fraction with concurrent weekly 40 mg/m² cisplatin. These patients also received ILBT boost with a dose of 5 Gy in 2 fractions given at an interval of 1 week. Another thirty six patients who were in CRT arm (arm B), were treated with external beam radiotherapy (EBRT) to a dose of 50 Gy in 25 fractions at 2 Gy per fraction with weekly 40 mg/m² cisplatin concurrently without brachytherapy (BT) boost. There was trend towards better median progression-free survival and treatment response in the CRT + ILBT group. Acute toxicities were slightly higher in the BT group. CRT followed by brachytherapy is an effective method for dose escalation in the management of esophageal cancer, especially for the patients who are considered inoperable. In locally advanced esophageal cancer, our study found that adding brachytherapy as a boost after concurrent chemoradiation improved treatment outcomes with slightly more acute, but manageable toxicity.