Endoluminal brachytherapy in the palliative treatment of advanced esophageal cancer, first clinical results

Introduction: Dysphagia is the main problem in patients with advanced nonresectable esophageal cancer. Palliation can be achieved by several treatment ways. We want to evaluate the efficacy of endoluminal brachytherapy (BT) for improvement of dysphagia, performance status, time of local tumor progress, and survival time. Methods: 6 patients with esophageal cancer stage IV received a palliative treatment with 192Ir HDR BT. The dose per fraction was 5 Gy, calculated 1 cm from the surface of the applicator, the total dose was 20 Gy (four weekly applications). Symptoms, performance status and life quality score were investigated before each application and each 4 weeks after treatment. The results were compared with 10 historical patients who were treated by implantation of nitinol stents (Ultraflex, Boston Scient. Inc.). Results: The tumor stages in the BT-group were T4, T3, T2 three, two and one, and in the stent group three, two and five, respectively. Dysphagia improved in median from grade 1.7 to grade 0.5 (BT group) and from grade 2.6 to grade 1.8 (stent group). Karnowski status improved in the BT group from 70 % to 85 %, but did not change in the stent group (75%). A strong correlation between improvement of dysphagia and life quality score could be found especially in patients with initial high grade dysphagia. The only side effect of BT mostly after the 3rd application was esophagitis grade 1 in 3 patients and grade 2 in 1 patient. Relief of the esophagitis after conservative therapy could be achieved within 1 week. In the BT group 3 patients were alive without local progress after 20, 13 and 2 weeks. The other 3 patients died from local progress (2 patients, after 20, 20 weeks) or from metastasis (1 patient, after 11 weeks). All patients in the stent group died from local progress. The median survival time is 17 ± 5.2 weeks in BT group vs. 8.8 ± 8.6 weeks in the stent group. Conclusion: Endoluminal brachytherapy seems to be an effective and well tolerable palliative treatment of advanced esophageal cancer despite the small number of patients. There was an improvement in dysphagia and quality of life in all BT patients. Time to local progress and survival time were longer in relation to the stent group