Moderate Dose Rate Intraluminal Brachytherapy after definitive chemoradiation for Esophageal Cancer

Esophageal carcinoma is an aggressive disease with a high incidence of locoregional recurrence. This study was designed to determine the feasibility and toxicity of chemotherapy, external beam radiation therapy (EBRT), and esophageal moderate dose rate (MDR) intraluminal brachytherapy (ILBT) in a potentially curable group of patients with squamous cell carcinoma of the esophagus. This study was considered important to determine the median survival time, local control, and late toxicity associated with this treatment regimen (MDR-ILBT). Between 2004 and 2007, 16 patients with esophageal cancer in the middle and lower third of esophagus were treated with 50.4 Grays (Gy) of external beam radiation (28 fractions given over 5.5 weeks) concurrently with cisplatin and 5-Fluoro Uracil, followed by MDR brachytherapy of 5 Gy during week 7. Chemotherapy was given during weeks 1, 5, 9, and 13, with cisplatin 75 mg/m2 on day 1 and 5-FU 750 mg/m2/day during days 1-4. All 16 patients had squamous histology. 14 patients (87.5%) completed external beam radiation plus at least two courses of chemotherapy, whereas two patients (12.5%) were able to complete EBRT without chemotherapy. The 2-year local recurrence-free survival rates were 71%. The 1-year and 2-year actuarial survival rates of all cases were 79.5% and 61.8%, respectively. Life-threatening toxicity or treatment-related deaths did not occur. There were no fistulas but there were two esophageal strictures. Local control and survival and adverse effects were determined with RTOG criteria. The addition of MDR-ILBT to chemoradiation did not have severe late complications and it improved local control. Therefore, it is a promising boost therapy after EBRT.