Optimization of single-fraction high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer: A preliminary report

Fifty-one untreated patients with advanced squamous cell carcinoma of the thoracic esophagus were entered into a randomized prospective study. The patients were randomized into four study groups for intraluminal brachytherapy. Group A patients (n=12) received treatment with 10 Gy; group B (n=14), 12 Gy; group C (n=14), 15 Gy; and group D (n=11), 18 Gy of single- fraction high dose rate intraluminal brachytherapy. The patients were followed up every month for four months. Relief of dysphagia and weight gain were seen in all evaluable patients in groups B and C; improvement of performance status was seen in all evaluable patients in group C in the third and fourth month. Four patients (two in group A and two in group B) developed stricture due to persistent disease after three months of follow-up. Four patients developed fibrotic strictures (one in group C and three in group D) within four months of follow-up. One patient in group D developed tracheoesophageal fistula and required intubation. Single-fraction high dose rate intraluminal brachytherapy of 12 to 15 Gy is likely to give the best results in terms of relief from dysphagia, weight gain, and improvement of performance status. Patients receiving this dose range should experience the least morbidity in terms of strictures and fistulae in palliation of advanced carcinoma of the esophagus.