Abstract
Esophageal Brachytherapy has been an option for recurrent or persistent esophageal cancer after standard chemoradiation therapy. RTOG 9207 utilized esophageal brachytherapy as a boost technique with 15 Gy in 3 fractions after chemotherapy and radiation. Preliminary analysis showed 17% fistula formation and since then the technique has been underutilized. We reviewed all patients that were treated at our institution in the last 5 years to assess disease outcomes including overall survival, local control and toxicity.
20 consecutive patients treated with high dose rate esophageal brachytherapy from 1/2017-12/2022 were included. All patients had received previous radiation with concurrent chemotherapy. All patients underwent placement of brachytherapy catheters under endoscopy guidance and were treated after CT based planning. Patients were prescribed 3-5 fractions depending on the previously received external beam dose. 5 Gy prescription dose was chosen per fraction to keep mucosal dose around 12 Gy per published literature. Median follow-up was 6 months (range 4-36 months). Data was collected on all patients to assess for local control, need for stent placement and fistula formation.
20 patients were included in this study. Median follow up was 6 months (range 4-36 months). 4/21 (25) were females and 16/20(75%) males. 76 fractions were treated in total. 3/20 (15%) patients received 5 fractions, 4/20 (25%) received 4 fractions, 9/20 (45%) received 3 fractions and 4/20 (25%) received 2 fractions of 5 Gy each. 7/76 (10%) fractions with a conventional 8mm single channel catheter and 69/76 (90%) were treated with balloon catheter. 4/20 (25%) patients were alive at the time of this report. 80% of patients showed improvement in dysphagia. Stenosis requiring dilatation occurred in 60%. Stenosis requiring stent occurred in 50% of either due to local progression of disease or stricture formation at least temporarily. 2/20 (10% patients were found to have fistula formation. First patient that developed a tracheoesophageal fistula at 12 months, had a history of tracheal involvement at the initial diagnosis. Second patient that developed a mediastinal fistula at 4 months was treated for postoperative anastomotic recurrence and all his fractions were treated with narrow lumen conventional catheter
In select patients, especially medically inoperable with early stage primary cancers or patients with recurrent or persistent disease, endoluminal HDR brachytherapy can be well-tolerated treatment option with low rates of toxicity. Widespread use of esophageal HDR brachytherapy has decreased use due to toxicity, but the use of newer balloon catheters and CT planning might contribute to our lower toxicity. Prospective study is warranted to determine the role of this technique in long-term control and cure of esophageal cancer as systemic and targeted therapy options offer better control of systemic disease and local control remains challenging.