Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients Journal Article


Authors: Folkert, M. R.; Cohen, G. N.; Wu, A. J.; Gerdes, H.; Schattner, M. A.; Markowitz, A. J.; Ludwig, E.; Ilson, D. H.; Bains, M. S.; Zelefsky, M. J.; Goodman, K. A.
Article Title: Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients
Abstract: Purpose: The management of superficial primary and recurrent esophageal cancer (EC) in medically inoperable patients is complex. Endoluminal high-dose-rate (HDR) brachytherapy has shown mixed results in terms of toxicity and local control. In this study, we examined the outcomes and toxicities in a set of patients with superficial primary and recurrent EC treated with a consistent HDR technique. Methods and Materials: Between 8/2008 and 7/2011, 14 patients were treated with HDR intraluminal brachytherapy, 10 (71.4%) with recurrent disease, and 4 (28.6%) with previously unirradiated lesions. Patients received three weekly fractions to a median dose of 12 Gy (range, 10-15 Gy); dose was prescribed to 7-mm median depth with mucosal dose limited to 8-10 Gy using a 12-14-mm applicator. Results: Median followup was 15.4 months. Overall freedom from failure (OFFF) and overall survival (OS) at 18 months were 30.8% (95% confidence interval [CI]: 5.2, 56.4) and 72.7% (95% CI: 45.3, 100), respectively. For patients with recurrent disease, OFFF and OS at 18 months were 11.1% (95% CI: 0, 32.1) and 55.6% (95% CI: 15.4, 95.8), respectively. For patients with previously unirradiated disease, OFFF and OS at 18 months were 75.0% (95% CI: 31.6, 100) and 100.0%, respectively. Eight (57.1%) patients had Grade 1 acute adverse effects; 6 (42.9%) patients had chronic Grade 1 adverse effects; 1 (7.1%) patient developed Grade 2 stricture. Grade 3 tracheoesophageal fistula occurred in 1 (7.1%) patient. One patient died before completion of treatment of unrelated causes. Conclusions: HDR endoluminal brachytherapy is a well-tolerated treatment for superficial primary and recurrent EC in medically inoperable patients. © 2013 American Brachytherapy Society.
Keywords: adult; cancer survival; clinical article; aged; treatment failure; overall survival; capecitabine; radiation dose; cancer staging; outcome assessment; recurrent cancer; follow up; radiation injury; radiation dose fractionation; brachytherapy; inoperable cancer; esophagus cancer; chemoradiotherapy; esophageal; fluoroscopy; tracheoesophageal fistula; esophagus ulcer; radiation applicator; hdr; endoluminal; medically inoperable; esophagus mucosa; esophagus stenosis
Journal Title: Brachytherapy
Volume: 12
Issue: 5
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2013-09-01
Start Page: 463
End Page: 470
Language: English
DOI: 10.1016/j.brachy.2012.12.001
PROVIDER: scopus
PUBMED: 23434221
DOI/URL:
Notes: --- - "Export Date: 1 October 2013" - "CODEN: BRACC" - "Source: Scopus"
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Michael J Zelefsky
    754 Zelefsky
  2. Hans Gerdes
    176 Gerdes
  3. Arnold J Markowitz
    139 Markowitz
  4. Karyn A Goodman
    257 Goodman
  5. Michael Ryan Folkert
    36 Folkert
  6. Gilad N Cohen
    182 Cohen
  7. Emmy Ludwig
    51 Ludwig
  8. Abraham Jing-Ching Wu
    404 Wu
  9. David H Ilson
    435 Ilson
  10. Mark Schattner
    169 Schattner
  11. Manjit S Bains
    338 Bains