Fractionated high dose rate intraluminal brachytherapy alone in palliation of advanced esophageal cancer: Preliminary report of a randomized prospective trial

Sixty-eight patients with stage III and IV carcinoma of the thoracic esophagus were randomized into three treatment groups to receive high dose rate intraluminal brachytherapy (HDR ILBT). Group A received 12 Gy in two fractions weekly (6 Gy per fraction); group B, 16 Gy in two fractions weekly (8 Gy per fraction); and group C, 18 Gy in three fractions weekly (6 Gy per fraction). All patients were followed up monthly and assessed for relief of dysphagia and weight gain. At six months, the dysphagia-free survival rate for all groups was 46%. Patients in group B did significantly better overall than those in group A. The overall survival rate for all groups was 86%. The complication-free survival rate was 78%, 82%, and 42% for groups A, B and C, respectively. Ten patients in group A had persistent tumor causing dysphagia. Patients in group C compared with those in group A, had significantly increased incidence of fibrotic strictures. Group B patients did the best in our study in terms of local control and overall, complication-free and dysphagia-free survival. HDR ILBT provided better results when compared with other currently available palliative modalities of treatment.