Influence of intraluminal brachytherapy dose on complications in the treatment of esophageal cancer.

PURPOSE

Demonstration of the influence of intraluminal brachytherapy dose on complications in the treatment of esophageal carcinoma.

METHODS AND MATERIALS

Between January 1990 and June 1991, 75 patients with esophageal cancer were treated with external radiotherapy followed by intraluminal brachytherapy. Patients had a Karnofsky score of over 70, with no supra-clavicular nodal or distant disease. An external radiotherapy dose between 40 and 55 Gy (mean 52 Gy), 5 times a week, 2 to 2.06 Gy/fraction, followed by a single session of Intraluminal brachytherapy using a locally developed, manual, afterloading applicator with Cs-137 sources with dose ranges of 8-10 Gy (Group 1: 42 patients), 10-12 Gy (Group 2: 11 patients), and 12-15 Gy (Group 3: 22 patients) at a mean dose rate of 2.09 Gy/hr was delivered.

RESULTS

The actuarial figures at 1 year were 39% for overall survival, 29% for disease-free survival, and 38% for local control. Fourteen patients (18.6%) developed complications of either an esophageal stricture or fistula. These were dependent on intra-luminal brachytherapy dose, whereas external radiotherapy and intra-luminal brachytherapy doses did not contribute significantly to local control. For Groups 1, 2, and 3, actuarial local control were 28%, 45%, and 63% (p < 0.1) and of complications were 6%, 20%, and 70% (p < 0.001), respectively. Also, on applying the Time/Dose/Fractionation formula on brachytherapy doses, it was found that the complication rate was 6% for TDF of < 31, 25% for TDF of 32-37, and 70% for TDF of > 38 (p < 0.001).

CONCLUSION

External radiotherapy doses in the range of 50 to 55 Gy followed by a dose of 10-12 Gy of intraluminal brachytherapy was found optimal with respect to complications and local control in the radiotherapeutic management of esophageal cancer.