Role of esophagogastroscopy in application and follow-up of high-dose-rate brachytherapy (HDRB) for treatment of esophageal carcinoma.

Flexible esophagogastroscopy (EG) and external beam radiotherapy (EBR) have become important means of diagnosing and treating both squamous and adenocarcinoma of the esophagus and gastroesophageal (GE) junction. Recently, new technology, termed high-dose-rate brachytherapy (HDRB), utilizing the placement of radioisotopes in the esophagus by endoscopic techniques has been introduced. This report describes the endoscopic application of the brachytherapy afterloading catheters and the additional role of EG in the posttreatment assessment of these patients. Twenty-four patients (21 esophageal, 3 GE junction) were treated using HDRB delivered by afterloading catheter techniques utilizing flexible EG. Radiation dosages ranged from 5 Gy (500 rads) to 8 Gy (800 rads) delivered to the tumor bed over an average of three applications. All patients were followed to assess swallowing ability, endoscopic evidence of tumor reduction, and complications resulting from intraluminal radiation therapy. Fifteen patients had reduction in intraluminal tumor based on endoscopic evaluation. Seven had partial or complete relief of dysphagia. Nine patients required gastrostomy tube placement for alimentation before or after therapy. Four patients had complications of perforation (1), fistula (1), or bleeding (2) after HDRB. Overall survival ranged from 2 to 27 months (mean = 8.9 months) after the first HDRB treatment. EG proved to be an efficient and safe technique for the introduction of intraluminal esophageal radiation therapy.