Chemosensitization and brachytherapy in palliation of advanced esophageal cancer

Brachytherapy has been shown to be effective for palliating advanced esophageal cancer. This report examines the role of brachytherapy and chemosensitization in a prospective randomized study. A total of 200 patients with inoperable, locally advanced esophageal cancer were randomized into four treatment groups. Chemosensitization was given with 5-fluorouracil 500 mg/m² as a continuous infusion for five days. Group A received high dose rate intraluminal brachytherapy (HDR ILBT) of 8 Gy per fraction on days two and four of chemosensitization. Group B received two fractions of 8 Gy HDR ILBT for five days without chemosensitization. Group C received HDR ILBT of 6 Gy on days one, three, and five of chemosensitization. Group D received three fractions of 6 Gy HDR ILBT over five days without chemosensitization. Patients were followed up monthly and assessed for relief of dysphagia, development of complications, and survival. The dysphagia-free survival rate was 18.8% at one year with a lower dysphagia-free survival rate in the chemosensitization groups (P>.05). The overall survival rate was 22.37% with a lower survival rate in the chemosensitization groups (P>.05). The incidence of fibrotic sutures was higher in the chemosensitization groups (P>.05). Persistent intraluminal disease was equal in the four groups. The treatment was safe with no associated morbidity or mortality from the brachytherapy. From this study, there is no role for chemosensitization with brachytherapy for advanced esophageal cancer. The addition of chemotherapy may lead to an increased incidence of strictures with earlier onset than with brachytherapy alone.