External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma

Muijs, Christina T.; Beukema, Jannet C.; Mul, Veronique E.; Plukker, John Th.; Sijtsema, Nanna M.; Langendijk, Johannes A.

doi:10.1016/j.radonc.2011.07.021

« Previous Next »Radiotherapy & Oncology
Volume 102, Issue 2 , Pages 303-308, February 2012

External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma

Christina T. Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Corresponding author. Address: Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9300 RB Groningen, The Netherlands.
Jannet C. Beukema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Veronique E. Mul
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
John Th. Plukker
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Nanna M. Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Johannes A. Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Received 29 December 2009; received in revised form 26 July 2011; accepted 26 July 2011. published online 01 September 2011.

Abstract

Purpose

To assess the effectiveness of definitive radiation therapy in patients with potentially curable esophageal cancer and to evaluate the side-effects of this treatment.

Methods and materials

Sixty-two patients with esophageal cancer, who were treated with definitive, curatively intended radiotherapy consisting of external radiotherapy (60Gy in 30 fractions), preceded and followed by LDR or HDR intraluminal brachy (12Gy in 2 fractions) were retrospectively analyzed.

Results

Recurrences were reported in 38 patients (61%), of which 25 (64%) failed locally first.

The overall survival rates at 1, 2 and 5years were 57%, 34% and 11%, respectively. The median overall survival was 15months. No prognostic factors could be identified. Most frequently reported treatment related toxicities were esophagitis, ulcerations, (11%) and strictures (16%). In 10 patients (16%) severe toxicities, were reported including grade III ulceration (2 cases), stricture (1 case), radiation pneumonitis (1 case), perforation (1 case), esophageal-pleural-tracheal fistula (1 case), and acute esophageal bleeding (4 cases). A history of gastrectomy was significantly associated with the development of severe toxicity.

Conclusion

Curatively intended radiotherapy alone can be offered to esophageal cancer patients, even when surgery and/or chemotherapy are not feasible. However, we observed severe toxicity in a substantial part of the patients. Given the relatively high rate of severe complications and the uncertainties regarding dose escalation, the addition of brachytherapy, with consequently high surface doses, should be limited to well-selected patients.

Keywords: Esophageal cancer, Radiotherapy, Intraluminal brachytherapy