Efficacy of intracavitary brachytherapy for recurrent esophageal cancer after radiotherapy

Objective: To discuss the preliminary efficacy and adverse reactions of intracavitary brachytherapy in the treatment of loco-regional recurrent (LR) esophageal cancer after radiotherapy. Methods: Iridium-192 brachytherapy was used to carry out intracavitary radiotherapy for 18 patients with LR esophageal cancer after initial radiotherapy from 2009 to 2013. A total irradiation dose of 16-30 Gy was given in 4-6 fractions (4-5 Gy per fraction). Intracavitary irradiation covered the lesion plus 1.0 cm upper and lower margins. The zero reference point was 10 mm far from the axis. Short-term efficacy, local control (LC) rate, overall survival (OS) rate, and adverse reactions were evaluated. Results: In the 18 patients, the follow-up rate was 100%; the overall response rate was 94%, with a complete response rate of 3/18, a partial response rate of 14/18, and a no response rate of 1/18. In 16 patients with clinical symptoms on admission, 13 showed remission (6 had symptoms disappearing and 7 had symptoms alleviated), 2 remained the same, and 1 got worse after treatment, yielding an overall clinical remission rate of 81%. In all the 18 patients, 6 patients had grade ≥ 2 radiation esophagitis (RE), consisting of 4 with grade 2 RE and 2 with grade 3 RE. One patient with esophageal stricture at 5 months after radiotherapy received gastric fistula surgery. The median time to LC was 14 months (3-38 months). The 1-, 2-, and 3-year LC rates were 72%, 44%, and 33%, respectively. The 1-, 2-, and 3-year OS rates were 61%, 22%, and 17%, respectively. The median OS time was 12 months (5.5-45.0 months). Fourteen deaths occurred in those patients, consisting of 12 cancer-related deaths and 2 non-cancer-related deaths. Conclusions: Intracavitary brachytherapy achieves satisfactory efficacy and significantly improves the symptoms in the treatment of LR after radiotherapy for esophageal cancer. (authors)