Intraluminal brachytherapy in carcinoma of the oesophagus: comparison of afterloading techniques

For improved local control or palliation of oesophageal cancers, Intra-luminal brachytherapy (ILB) has emerged as an increasingly popular treatment modality of therapy in recent years. In combination with external radiotherapy, afterloaded ILB can increase local control rates and may prolong survival of these patients. In this paper two techniques of ILB viz., manual and low dose-rate remote after loading methods, using Caesium-137 tubes and pellets respectively, are described in detail. On comparison of these two techniques it was found that both of them were similar with respect to their physical characteristics (dose rate, dose fall-off, maximum spinal cord dose, total reference air kerma, etc.). Clinically, the manual afterloaded ILB technique was found to be easier to use when compared with the low-dose rate remote afterloader. In addition, the number of patients with uterine cancers being high in a developing country, it was found that it was inappropriate to use the low dose remote afterloaders, designed for use in gynaecological cancers, for ILB of oesophageal cancers. Therefore, in the absence of high dose rate afterloaders, which can be utilized for intracavitary treatments of both uterine and oesophageal malignancies effectively, the manual after-loading ILB system as described in this paper could be a practical alternative. Cancer Oesophagus, Intraluminal radiotherapy technique.