Treatment of oesophagus cancer by high dose rate brachytherapy (HDRB)

Aims: Assessment efficacy of HDRB with Ir192 in 34 patients with locally advanced cancer of oesophagus. Patients: 34 patients (6 females, 28 males) were treated by HDRB exclusively or associated with conventional treatments (Chemotherapy (CT), Radiotherapy (RT), and/or Surgery (SG)) and 119 procedures were applied, each patients received between 1 and 6 fractions (the time between each of them was 7 days). The dose delivered during each fraction was from 4 to 8 Gy. Median age of the population was 65 years, performance status (Karnowski) was 70%. 15 patients were treated with curative intent. (SG was excluded): 10 of them received CT (4 neoadjuvant and 7 concomitant with external RT). The external radiotherapy delivered 20 to 65 Gy. 17 patients were treated with palliative intent: SG excluded, recurrence after RT or progression of the tumor under CT. Technic: HDRB was applied after positioning an applicator during a therapeutic endoscopy used to introduce a leader intraluminaly in the oesophagus down to the stomach. The tumor levels were noted by the endoscopy and reported on orthogonal X-RAYS of the chest, on the base of the X-RAYS, the computed dosimetry was performed. Results: The prescription dose was defined at the applicator surface or at 5 mm depth of it, the mean length treated was 69 mm and mean volume treated was 19 cm3; the median dose delivered was 14 Gy (8 to 24) in curative intent and 15 Gy (8 to 30) in palliative intent. The tolerance was good, (better with neurolept analgesia). The 34 treated patients are evaluable. For patients treated with palliative intent a decrease of dysphagia was observed in 70% of the cases for a median time of 8 months. In the patients treated with curative intention 11 completed remission, were obtained, and 3 of them relapsed, 9 to 19 months after the HDRB. 8 alive with 10 to 38 months follow up 4 progressions, all died, with 4 to 14 months follow up. Conclusion: According to this results the HDRB seems to be efficient and warrants it use in combination with conventional treatments