High Dose Rate Intraluminal Brachytherapy (HDRILBT) as a Boost to External Beam Radiation Therapy (EBRT)in Advanced Inoperable Carcinoma Esophagus

Aim of study: In certain clinical situations HDRILBT may be an effective alternative modality as a boost to external beam radiation therapy in advanced inoperable carcinoma esophagus. In this study, we evaluated the feasibility, complications and short term response of HDRILBT used as a boost after completion of 40 Gy EBRT with curative intent in inoperable advance stage esophageal cancer. Materials and Methods: After 40 Gy EBRT, 28 patients who could be intubated with 16 F Levine’s tube was given high dose rate (HDRILBT) and formed the study group. The prescription point was at 1 cm from the central axis of the oesophageal catheter. A total dose of 10 Gy in 2 fractions at weekly intervals was prescribed. Results: Treatment result was analysed after 3 months of completion of treatment. It was consisted of clinical evaluation, endoscopic evaluation and contrast enhanced CT scan thorax of the patients. Grade 1 & 2 oesophagitis was seen in 21 patients. 3 patients had Grade 3 & 4 oesophagitis (RTOG scale). Stricture formation was seen in 3 patients. In one patient, tracheoesophageal fistula was developed 3 months after treatment. Complete Response was seen in 20 patients (71%). Partial response was seen in 4 patients (14%). Stationary and progressive disease was seen in 4 patients (14%). Relief in dysphagia was seen in 22 (78%) patients. Conclusion: In selected cases use of HDRILBT as a boost to EBRT is a feasible option to obtain a higher dose for improved local control with acceptable complications.