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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 10
Original paper

Comparative study of concomitant chemoradiation versus concomitant chemoradiation followed by high-dose-rate intraluminal brachytherapy in locally advanced esophageal carcinoma: a single institutional study

Anirban Halder, Rituparna Biswas, Anshuman Ghosh, Aloke Ghosh Dastidar

J Contemp Brachytherapy 2018; 10, 3: 225–231
Online publish date: 2018/06/29
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The aim of this study is to compare efficacy and toxicity between concurrent chemoradiotherapy (CCRT) followed by high-dose-rate intraluminal brachytherapy (ILBT) and CCRT in inoperable, locally advanced esophageal carcinoma.

Material and methods
Thirty-four patients with inoperable, locally advanced esophageal carcinoma were randomized into two arms. In the CCRT + ILBT arm (arm A), eighteen patients received 50.4 Gy at 1.8 Gy per fraction over 5.6 weeks, along with concurrent cisplatin (75 mg/m2) intravenously on day 1, and 5-fluorouracil (1000 mg/m2) continuous intravenous infusion on days 1-5, starting on the first day of irradiation and repeated after 28 days. This was followed by ILBT boost with a dose of 10 Gy in 2 fractions, one week apart. In the CCRT arm (arm B), sixteen patients received two cycles of chemotherapy, using the same schedule, along with external beam radiotherapy fractionated in a similar manner without brachytherapy boost. The endpoints were tumor response, acute and late toxicities, disease and progression-free survival.

With a median follow-up of 13 months, the complete response rate was 88.89% in arm A and 87.50% in arm B (p = 0.71). Acute esophageal toxicity was higher in CCRT followed by ILBT arm (p = 0.6). There was no significant difference between the Kaplan Meier survival plots of disease-free survival (p = 0.678) and progression-free survival (p = 0.548).

In our study, addition of brachytherapy as a boost following concurrent chemoradiation failed to improve treatment outcomes without additional toxicity in locally advanced esophageal cancer.


concurrent chemoradiotherapy, disease-free survival, esophageal cancer, intraluminal brachytherapy

Parkin DM, Bray F, Ferlay J et al. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108.
Pennathur A, Farkas A, Krasinskas AM et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg 2009; 87: 1048-1055.
Cooper JS, Guo MD, Herskovic A  et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a  prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999; 281: 1623-1627.
DeVita VT Jr, Lawrence TS, Rosenberg SA (eds.). Cancer: Principles & Practice of Oncology. Wolters Kluwer, Philadelphia 2015; 582.
Safaei AM, Ghalehtaki R, Khanjani N et al. High-dose-rate intraluminal brachytherapy prior to external radiochemotherapy in locally advanced esophageal cancer: preliminary results. J Contemp Brachytherapy 2017; 9: 30-35.
Jemal A, Siegel R, Xu J et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300.
Wong R, Malthaner R, Zuraw L et al.; Cancer Care Ontario Practice Guidelines Initiative Gastrointestinal Cancer Disease Site Group. Combined modality radiotherapy and chemo­ therapy in nonsurgical management of localized carcinoma of the esophagus: a  practice guideline. Int J Radiat Oncol Biol Phys 2003; 55: 930-942.
Smith T, Ryan L, Douglass H et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a  study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys 1998; 42: 269-276.
Hennequin C, Gayet B, Sauvanet A  et al. Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus. Int J Radiat Oncol Biol Phys 2001; 49: 657-664.
Geh JI, Bond SJ, Bentzen SM et al. Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oeso­ phageal cancer: Evidence of a  radiation and chemotherapy dose response. Radiother Oncol 2006; 78: 236-244.
Zhang Z, Liao Z, Jin J et al. Dose-response relationship in locoregional control for patients with stage II-III esophageal cancer treated with concurrent chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61: 656-664.
Suh YG, Lee IJ, Koom WS et al. High-dose Versus Standard-dose Radiotherapy with Concurrent Chemotherapy in Stages II–III Esophageal Cancer. Jap J Clin Oncol 2014; 44: 534-540.
Staar S, Mueller RP, Achterrath W. Intensified treatment for inoperable esophagus cancer: simultaneous radiochemotherapy combined with HDR intraluminal brachytherapy-results of a  phase II trial [abstract]. Proc ASCO 1993; 12: 223.
Montravadi RVP, Gates JO, Bajpai D et al. Combined chemo­ therapy and external radiation therapy plus intraluminal boost with high dose rate brachytherapy for carcinoma of the esophagus. Endocuriether Hyperthermia Oncol 1995; 11: 223-233.
Gaspar LE, Qian C, Kocha WI et al. A  phase I/II study of external beam radiation, brachytherapy and concurrent chemo­ therapy in localized cancer of the esophagus (RTOG 92-07): preliminary toxicity report. Int J Radiat Oncol Biol Phys 1997; 37: 593-539.
Vuong T, Szego P, David M et al. The safety and usefulness of high-dose-rate endoluminal brachytherapy as a  boost in the treatment of patients with esophageal cancer with external beam radiation with or without chemotherapy. Int J Radiat Oncol Biol Phys 2005; 63: 758-764.
Khurana R, Dimri K, Lal P et al. Factors influencing the development of ulcers and strictures in carcinoma of the esophagus treated with radiotherapy with or without concurrent chemotherapy. J Cancer Res Ther 2007; 3: 2-7.
Calais G, Dorval E, Louisot P et al. Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for Stages IIB and III esophageal carcinoma: Results of a  pilot study. Int J Radiat Oncol Biol Phys 1997; 38: 769-775.
Chatani M, Matayoshi Y, Masaki N. Radiation therapy for the esophageal carcinoma: External irradiation versus high dose rate intraluminal irradiation. Strahlenter Onkol 1992; 168: 328-332.
Fietkau R, Grabenbauer GG, Sauer R. Radiotherapy of esophageal cancer. Results following radiotherapy alone and simultaneous radiochemotherapy and intracavitary irradiation. Strahlenther Onkol 1994; 170: 69-78 [Article in German].
Yorozu A, Dokiya T, Oki Y et al. Curative radiotherapy with high-dose-rate brachytherapy boost for localized esophageal carcinoma: Dose-effect relationship of brachytherapy with the balloon type applicator system. Radiother Oncol 1999; 51: 133-139.
Nishimura Y, Okuno Y, Ono K et al. External beam radiation therapy with or without high-dose-rate intraluminal brachytherapy for patients with superficial esophageal carcinoma. Cancer 1999; 86: 220-228.
Chauhan A, Kaur P, Annex E. Radical External Beam Radiotherapy with Intraluminal High Rate Dose Brachytherapy in Patients with Carcinoma Esophagus. Internet J Gastroenterol 2008; 8.
Sharma V, Agarwal J, Dinshaw K et al. Late esophageal toxicity using a  combination of external beam radiation, intraluminal brachytherapy and 5-fluorouracil infusion in carcinoma of the esophagus. Dis Esophagus 2000; 13: 219-225.
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