Background:
A multiinstitutional, prospective study of the radiation therapy oncology group (rtog) was designed to determine the feasibility and toxicity of chemotherapy, external beam radiation, and esophageal brachytherapy (eb) in a potentially curable group of patients with adenocarcinoma or squamous cell carcinoma of the esophagus. a preliminary analysis indicated a 17% 1-year actuarial risk of treatment-related fistulas. a final analysis of this study was considered important to determine the median survival time, local control, and late toxicity associated with this treatment regimen.
Methods:
Planned treatment was 50 grays (gy) of external beam radiation (25 fractions given over 5 weeks) followed 2 weeks later by eb (either high-dose-rate 5 gy during weeks 8, 9, and 10, for a total of 15 gy, or low-dose-rate 20 gy during week 8). chemotherapy was given during weeks 1, 5, 8, and 11, with cisplatin 75 mg/m(2) and 5-fluorouracil 1000 mg/m(2)/24 hours in a 96-hour infusion.
Results:
Of the 49 eligible patients, 45 (92%) had squamous histology and 4 (6%) had adenocarcinoma. forty-seven patients (96%) completed external beam radiation plus at least 2 courses of chemotherapy, whereas 34 patients (69%) were able to complete external beam radiation, eb, and at least 2 courses of chemotherapy. the estimated survival rate at 12 months was 49%, with an estimated median survival of 11 months. life-threatening toxicity or treatment-related death occurred in 12 (24%) and 5 (10%) cases, respectively. treatment-related esophageal fistulas occurred in 6 cases (12% overall, 14% of patients starting eb) at 0.5-6.2 months from the first day of brachytherapy, leading to death in 3 cases.
Conclusions:
In this study, severe toxicity, including treatment-related fistulas, occurred within 7 months of brachytherapy. based on the 12% incidence of fistulas, the authors continue to urge caution in employing eb, particularly when used in conjunction with chemotherapy.