[Percutaneous and intraluminal radiotherapy and radiochemotherapy in esophageal carcinoma]

Next to standard external beam radiation therapy, combined treatment schedules of percutaneous and endoluminal radiotherapy as well as simultaneous radiochemotherapy became important over the past ten years, especially for primarily inoperable, advanced carcinomas of the esophagus. Analyzing representative treatment protocols, the following conclusions are evident: the combination of external high-voltage therapy and endoluminal brachytherapy using high-dose afterloading techniques leads to intensified biologically effective tumor doses with increasing tumor control. The simultaneous application for radio- and chemotherapy with 5-fluorouracil, cisplatinum or mitomycin results in a longer median survival compared to irradiation alone, and it is comparable to results in historical controls with radical esophagectomy. Up to now, no reduction of distant metastases was seen after simultaneous radiochemotherapy regimen alone. There is some evidence, that intensified chemotherapy before or after radiochemotherapy might result in improved survival rates and decreased distant metastases.