A prospective clinical study of intracavitary brachytherapy combined with external beam irradiation for esophageal carcinoma

Objective: To investigate the effectiveness and side-effects of booster brachytherapy after different doses of external beam irradiation and to determine the proper time for brachytherapy in esophageal carcinoma. Methods: One hundred eligible patients with esophageal carcinoma were randomized into two groups (group A and group B). In group A , an intracavitary booster brachytherapy was given concomitantly with an external beam irradiation (EBI) when the total dose of EBI reached 35 Gy. While in the group B, the intracavitary booster brachytherapy was given just after EBI reached 50 Gy. The total dose of EBI in both groups was 50 Gy (2 Gy per fraction, 1 time a day for 5 days per week). Five Gy of intracavitary brachytherapy was given once a week for 2 times. EBI was not given during the day of brachytherapy. Results: The 1-, 3-, 5-year local control rates were respectively 60.2%, 39.8%, 36.2% in group A and 54.1%, 32.8%, 29.2% in group B (P=0.5118) and the 1-, 3-, 5-year survival rates were respectively 52.0%, 26.0%, 21.8% and 54.0%, 23.4%, 16.7% (P=0.8159). The esophagitis rate in group A and group B was 70% and 48% respectively with P=0.038. But the rate of severe esophagitis was the same in the two groups. The fistula rate was 8% and 10%, respectively. Conclusion: Intracavitary booster brachytherapy was feasible either after 35 Gy or 50 Gy of EBI in esophageal carcinoma. A higher morbidity of acute esophagitis was observed in group A than in group B. Both protocols are tolerable. (authors)