The results are reported of HDR intracavitary
brachytherapy in 134 esophageal
carcinoma patients (110 men and 24 women) treated in 10 Italian centers. Forty-one patients received radical treatment and
brachytherapy was often combined with external irradiation and/or
chemotherapy. Clinical response rates follow: 56% complete remissions, 34% partial remissions, 10% no response/
disease progression and not assessed. Ninety-three patients underwent
palliative treatment:
dysphagia was reduced in 80% of them and
pain was reduced in 71% of them. Treatment-induced esophageal damage consisted in G3-G4
esophagitis (5% of patients),
strictures (10%) and
fistulas (3%). Complication rates were correlated with fraction dose (9.5% complications for fraction doses < 500 cGy, 20% with doses ranging 500-800 cGy and 38% with fraction doses > 800 cGy). Moreover, the esophagus was more severely injured when small tubes were used (24% with tubes phi < 2 mm, 19% with tubes phi 2-6 mm and 5% with tubes phi > 6 mm). When external irradiation was combined with
brachytherapy,
dysphagia was more relieved than with
brachytherapy alone (89% vs. 71%), with no increase in complication rates. Also the
chemotherapy-
brachytherapy combination improved swallowing more than
brachytherapy alone (88% vs. 79%) and once again complication rates did not increase. To conclude, in the radical treatment of esophageal
carcinoma, HDR
brachytherapy permits higher radiation doses to be delivered, with fair complication rates. As for
palliative treatment, HDR
brachytherapy is safe, has low morbidity and provides adequate relief of
dysphagia in 80% of patients. We suggest the use of tubes phi > 6 mm and fraction doses ranging 5-6 Gy.