Brachytherapy in oesophageal carcinoma

Area of Science:

• Oncology
• Palliative Care
• Radiation Oncology

Background:

• Esophageal carcinoma, particularly recurrent or locally advanced stages, presents a poor prognosis.
• Dysphagia is a primary concern, necessitating palliative interventions.
• Existing treatments like laser, prosthetics, dilatation, external beam irradiation (EBI), and intraluminal brachytherapy (IBT) aim to alleviate dysphagia.

Purpose of the Study:

• To evaluate the efficacy and safety of low dose rate intraluminal brachytherapy (IBT) for dysphagia palliation in patients with esophageal carcinoma.
• To assess the impact of IBT on swallowing function and patient survival.
• To compare IBT with other palliative treatment options, especially in recurrent cases.

Main Methods:

• A retrospective review of 11 patients with esophageal carcinoma (8 recurrent, 3 newly diagnosed).
• Treatment involved low dose rate intraluminal brachytherapy (IBT).
• Outcomes assessed included dysphagia relief, swallowing ability, toxicity, and survival.

Main Results:

• Dysphagia relief was achieved in 9 out of 11 patients.
• All successfully treated patients could swallow at least a semi-solid diet until death or last follow-up.
• Toxicity was minimal, but median survival was poor at 3 months.
• IBT demonstrated advantages over EBI in recurrent cases due to normal tissue tolerance.

Conclusions:

• Low dose rate IBT is a highly effective palliative treatment for dysphagia in esophageal cancer.
• IBT offers advantages in recurrent disease where re-irradiation with EBI is challenging.
• The procedure is quick (1-2 days), has low morbidity, and provides durable palliation.