Late esophageal toxicity using a combination of external beam radiation, intraluminal brachytherapy and 5-fluorouracil infusion in carcinoma of the esophagus

Abstract

One hundred patients with potentially curable squamous cell carcinoma of the esophagus were treated using a combination of external beam radiation, medium-dose intraluminal brachytherapy (ILBT), and 5-¯uorouracil infusion (as a radiosensitizer) from January 1990 to December 1993. The main objective was to determine late toxicity and optimization of the dose of intraluminal radiation. All patients had external radiation of 50 Gy over 5 weeks, followed by ILBT of 20 Gy for 50 patients (group 1) and 15 Gy for a subsequent 50 patients (group 2), using a dose rate of 315±330 cGy/h with the prescription at 1 cm o axis. The 5-¯uorouracil infusion was 500 mg/m 2 administered 12 h prior to ILBT. The treatment-related complications among groups 1 and 2 were strictures 24% vs. 8% (p=0.029), ulceration 30% vs. 28% (p=0.8), and tracheoesophageal ®stulae 12% for both groups. The overall survival for groups 1 and 2 was 8% and 23% at 5 years. The development of life-threatening complications is a major concern and extreme caution is urged before selecting patients for a combination of ILBT and 5-¯uorouracil treatment.

Treatment outcomes after intraluminal brachytherapy following definitive chemoradiotherapy in patients with esophageal cancer

“…Notably, the patients in this study were administered chemotherapy just prior to ILRT. [19] Significantly fewer incidences of strictures was seen when ILRT dose was reduced from 20 to 15 Gy (24% vs 8%). The retrospective report on factors affecting the development of strictures following treatment of esophageal carcinoma also found highest complication rates among patients receiving concurrent chemoradiotherapy followed by brachytherapy.…”

“…Complications following the use of ILRT with chemoradiotherapy have been varyingly reported by different investigators. While Montravadi et al, [4] reported no patient developing fistula post treatment, Sharma et al, [19] on the other hand reported a 12% incidence of fistula formation and 29% incidence of post-treatment esophageal ulcers. Notably, the patients in this study were administered chemotherapy just prior to ILRT.…”

Intraluminal brachytherapy in the management of squamous carcinoma of the esophagus

“…A randomized trial has already demonstrated that combined therapy is superior to EBRT alone, but whether EBRT adds anything to brachytherapy has not yet been established 13 . Adding chemotherapy to brachytherapy or EBRT in patients with poor performance status, low BMI, and significant comorbidities, has been shown to increase toxicities, including local esophageal scarring and fistulae that can make dysphagia worse 14,15 . However, subsequent to local therapy to the esophagus that palliates dysphagia, patients can improve eating, weight and performance status.…”