To induce fast relief of
dysphagia in patients with oesophageal
cancer high dose rate (HDR)
brachytherapy was applied before external
radiotherapy in a prospective study. Seventy-four patients with inoperable oesophageal
cancer (36 squamous cell, 38
adenocarcinoma) were treated with a combination of 10 Gy HDR
brachytherapy, followed by 40 Gy in 4 weeks external beam
radiotherapy (EBRT), starting 2 weeks later. Tumour response, as measured by endoscopy and/or
barium swallow, revealed complete remission in 21 and partial response in 38 patients (overall response rate 80%). Improvement of
dysphagia was induced by
brachytherapy within a few days in 39%, and achieved at the end of treatment in 70% of patients. Further
weight loss was prevented in 39 of the 59 patients who presented with
weight loss.
Pain at presentation improved in 12 out of 25 patients. Median survival was 9 months. No differences in either response rate or survival were found in squamous cell or
adenocarcinoma. Side-effects were either acute with minimal discomfort in 32 (42%) or late with painful ulceration in five patients (7%), occurring after a median of 4 months. A
fistula developed in six patients, all with concurrent tumour. In conclusion,
brachytherapy before EBRT was a safe and effective procedure to induce rapid relief of
dysphagia, especially when combined with EBRT.