Hostname: page-component-77c89778f8-swr86 Total loading time: 0 Render date: 2024-07-20T00:08:23.736Z Has data issue: false hasContentIssue false
  • English
  • Français

Brachytherapy for Oesophageal Carcinoma: A Comprehensive Review of Literature and Techniques

Published online by Cambridge University Press:  18 January 2021

Rashi Kulshrestha ,
Anil Gupta Open the ORCID record for Anil Gupta [Opens in a new window] ,
Daya Nand Sharma  and
Kishore Singh
Rashi Kulshrestha
Affiliation:
Radiation Oncology, BC Cancer Agency, Abbotsford, British Columbia, BC V2S 0C2, Canada
Anil Gupta*
Affiliation:
Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
Daya Nand Sharma
Affiliation:
Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
Kishore Singh
Affiliation:
Radiation Oncology, Maulana Azad Medical College, New Delhi, Delhi, 110002, India
*
Author for correspondence: Anil Gupta, Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, 110029, India. E-mail: anilgupta87@outlook.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Oesophageal carcinoma is one of the fatal cancers mainly because of its rapid spread and poor prognosis. Treatment modalities involves a multimodality approach, including surgery, radiation therapy and chemotherapy. Radiation therapy includes brachytherapy in the form of intraluminal radiation therapy. Brachytherapy permits delivery of high tumouricidal doses to superficial cancerous growth of the oesophagus while delivering much lower doses to the surrounding tissue. It is mostly given in combination with external beam radiation in patients with poor performance scores not likely to tolerate an aggressive chemoradiation regimen or as a boost to concurrent chemoradiotherapy. It is very effective in terms of local tumour control as well as in relieving symptoms in advanced/recurrent disease. Intraoperative brachytherapy and seed brachytherapy have also been tried to address the nodal disease.

Methods:

We undertook a review of the available literature and techniques developed in the past three decades to emphasise the role of brachytherapy in curative or palliative settings in the treatment of oesophageal carcinoma.

Conclusion:

Oesophageal brachytherapy will remain a tangible treatment of oesophageal cancer, although it is less commonly used due to high expertise requirement, lack of established evidence, risk of life-threatening complications and lack of interest in brachytherapy. It offers quick and useful palliation for a prolonged period, along with good quality of life and superior dosimetry. Use of novel applicators may allow dose escalation and lower toxicity. Seed brachytherapy is also emerging as a promising option in nodal recurrences.

Keywords

brachytherapy applicatorsoesophageal cancerintraluminal radiation therapy (ILRT)intraoperative brachytherapyseed brachytherapy
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 2 , June 2022 , pp. 267 - 276
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bray, F, Ferlay, J, Soerjomataram, I, Siegel, RL, Torre, LA, Jemal, A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424. doi: 10.3322/caac.21492 CrossRefGoogle ScholarPubMed
Lepage, C, Rachet, B, Jooste, V, Faivre, J, Coleman, MP. Continuing rapid increase in esophageal adenocarcinoma in England and Wales. Am J Gastroenterol. 2008; 103(11): 2694–2699. doi: 10.1111/j.1572-0241.2008.02191.x CrossRefGoogle ScholarPubMed
Gaspar, LE, Nag, S, Herskovic, A, Mantravadi, R, Speiser, B. American brachytherapy society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Int J Radiat Oncol Biol Phys. 1997; 38(1): 127–132. doi: 10.1016/S0360-3016(97)00231-9 CrossRefGoogle ScholarPubMed
Homs, MYV, Steyerberg, EW, Eijkenboom, WMH, et al. Single-Dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004; 364(9444): 1497–1504. doi: 10.1016/S0140-6736(04)17272-3 CrossRefGoogle ScholarPubMed
Raval, M, Zouain, N. The effectiveness of high dose rate brachytherapy using a special applicator set with external beam radiation treatment and chemotherapy followed by surgery as a treatment of adenocarcinoma of the esophagus : A case series of single institution with literature review. J. Cancer Res. Exp. Oncol. 2011; 3(January): 1–7. doi: 10.5897/JCREO.9000027.Google Scholar
Buzurovic, IM, Hansen, JL, Bhagwat, MS, et al. Clinical implementation of a novel applicator in high-dose-rate brachytherapy treatment of esophageal cancer. J Contemp Brachytherapy. 2016; 8(4): 319–325. doi: 10.5114/jcb.2016.61933 CrossRefGoogle ScholarPubMed
Taggar, AS, Pitter, KL, Cohen, GN, et al. Endoluminal high-dose-rate brachytherapy for locally recurrent or persistent esophageal cancer. Brachytherapy. 2018; 17(3): 621–627. doi: 10.1016/j.brachy.2018.01.010 CrossRefGoogle ScholarPubMed
Berger, D, Schmid, R, Wisgrill, B, et al. Endoscope-guidable multichannel applicator for brachytherapy of esophageal cancer. Brachytherapy. 2017; 16(3): S85. doi: 10.1016/j.brachy.2017.04.158 CrossRefGoogle Scholar
Reci, R, Lundgren, L, Förnvik, D, Engelholm, S. High dose rate intraluminal brachytherapy for oesophageal cancer using MR imaging: A clinical implementation. https://lup.lub.lu.se/luur/download?func=downloadFile&recordOId=8147434&fileOId=8147438.Google Scholar
Yorozu, A, Dokiya, T. Brachytherapy for esophageal cancer: optimum dose and indications in the modern era. In: Yoshioka Y, Jun I, Oguchi M, Nakano T (eds). Brachytherapy. Springer, Singapore; 2018: 283–300. https://doi.org/10.1007/978–981–13–0490–3_21 CrossRefGoogle Scholar
Sur, RK. Radiation therapy of esophageal cancer: role of high dose rate brachytherapy. Int J Radiat Oncol Biol Phys. 1992; 22(5): 1043–1046. doi: 10.1016/0360–3016(92)90805-R CrossRefGoogle ScholarPubMed
Kapoor, R, Bansal, A, Kocchar, R, Kumar, P, Sharma, SC. Effectiveness of two high-dose-rate intraluminal brachytherapy schedules for symptom palliation in carcinoma esophagus: a tertiary care center experience. Indian J Palliat Care. 2012; 18(1): 34–39. doi: 10.4103/0973-1075.97347 CrossRefGoogle ScholarPubMed
Sharan, K, Fernandes, D, Prakash Saxena, P, Banerjee, S, Sathian, B. Treatment outcomes after intraluminal brachytherapy following definitive chemoradiotherapy in patients with esophageal cancer. J Cancer Res Ther. 2014; 10(2): 337–341. doi: 10.4103/0973-1482.136623 Google ScholarPubMed
Tamaki, T, Ishikawa, H, Takahashi, T, et al. Comparison of efficacy and safety of low-dose-rate vs. high-dose-rate intraluminal brachytherapy boost in patients with superficial esophageal cancer. Brachytherapy. 2012; 11(2): 130–136. doi: 10.1016/j.brachy.2011.05.008 CrossRefGoogle ScholarPubMed
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(3): 758–764. doi: 10.1016/j.ijrobp.2005.02.042 CrossRefGoogle ScholarPubMed
Brunner, TB, Rupp, A, Melzner, W, Grabenbauer, GG, Sauer, R. Esophageal cancer: A prospective phase II study of concomitant-boost external-beam chemoradiation with a top-up endoluminal boost. Strahlentherapie und Onkol. 2008; 184(1): 15–22. doi: 10.1007/s00066-008-1787-5 CrossRefGoogle ScholarPubMed
Sur, RK, Donde, B, Conrad, F, et al. Randomized prospective study comparing high-dose-rate intraluminal brachytherapy (HDRILBT) alone with HDRILBT and external beam radiotherapy in the palliation of advanced esophageal cancer. Brachytherapy. 2004; 3: 191–195. doi: 0.1016/j.brachy.2004.09.004 CrossRefGoogle ScholarPubMed
Rosenblatt, E, Jones, G, Sur, RK, et al. Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell oesophageal cancer: a prospective multi-centre randomized trial of the International Atomic Energy Agency. Radiother Oncol. 2010;97(3):488–494. doi: 10.1016/j.radonc.2010.09.001 CrossRefGoogle ScholarPubMed
Sur, RK, Donde, B, Levin, VC, Mannell, A. Fractionated high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 1998;40(2):447–453. doi: 10.1016/s0360-3016(97)00710-4 CrossRefGoogle ScholarPubMed
Sur, RK, Levin, CV, Donde, B, Sharma, V, Miszczyk, L, Nag, S. Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma - An International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys. 2002;53(1):127–133. doi: 10.1016/S0360-3016(02)02702-5 CrossRefGoogle ScholarPubMed
Fuccio, L, Mandolesi, D, Farioli, A, et al. Brachytherapy for the palliation of dysphagia owing to esophageal cancer: A systematic review and meta-analysis of prospective studies. Radiother Oncol. 2017; 122(3): 332–339. doi: 10.1016/j.radonc.2016.12.034 CrossRefGoogle ScholarPubMed
Gaspar, LE, Winter, K, Kocha, WI, Coia, LR, Herskovic, A, Graham, M. A phase i/ii study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207). Cancer. 2000; 88(5): 988–995. doi: 10.1002/(SICI)1097–0142(20000301)88:5<988:AID-CNCR7>3.0.CO;2-U 3.0.CO;2-U>CrossRefGoogle Scholar
Isono, K, Onoda, S, Ishikawa, T, Sato, H, Nakayama, K. Studies on the causes of deaths from esophageal carcinoma. Cancer. 1982; 49(10): 2173–2179. doi: 10.1002/1097–0142(19820515)49:10<2173:AID-CNCR2820491032>3.0.CO;2-Z 3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Shimada, H, Kitabayashi, H, Nabeya, Y, et al. Treatment response and prognosis of patients after recurrence of esophageal cancer. Surgery. 2003; 133(1): 24–31. doi: 10.1067/msy.2003.31 CrossRefGoogle ScholarPubMed
Ziegler, K, Sanft, C, Friedrich, M, Stein, H, Haring, R, Riecken, EO. Evaluation of endosonography in TN staging of oesophageal cancer. Gut. 1991; 32(1): 16–20. doi: 10.1136/gut.32.1.16 CrossRefGoogle ScholarPubMed
Gao, F, Li, C, Gu, Y, Huang, J, Wu, P. CT-guided 125I brachytherapy for mediastinal metastatic lymph nodes recurrence from esophageal carcinoma: effectiveness and safety in 16 patients. Eur J Radiol. 2013; 82(2): e70–e75. doi: 10.1016/j.ejrad.2012.09.003 CrossRefGoogle ScholarPubMed
Lah, JJ, Kuo, J V., Chang, KJ, Nguyen, PT. EUS-guided brachytherapy. Gastrointest Endosc. 2005; 62(5): 805–808. doi: 10.1016/j.gie.2005.07.019 CrossRefGoogle ScholarPubMed
Guo, JH, Teng, GJ, Zhu, GY, et al. Self-Expandable esophageal stent loaded with 125I seeds: initial experience in patients with advanced esophageal cancer. Radiology. 2008; 247(2): 574–581. doi: 10.1148/radiol.2472070999 CrossRefGoogle ScholarPubMed
Tamaki, Y, Sasaki, R, Ejima, Y, et al. Efficacy of intraoperative radiotherapy targeted to the abdominal lymph node area in patients with esophageal carcinoma. J Radiat Res. 2012; 53(6): 882–891. doi: 10.1093/jrr/rrs045 CrossRefGoogle Scholar
Arimoto, T, Takamura, A, Tomita, M, Suzuki, K, Hosokawa, M, Kaneko, Y. Intraoperative radiotherapy for esophageal carcinoma- Significance of tort dose for the incidence of fatal tracheal complication. Int J Radiat Oncol Biol Phys. 1993; 27(5): 1063–1067. doi: 10.1016/0360-3016(93)90524-Y CrossRefGoogle Scholar
Murakami, M, Kuroda, Y, Nakajima, T, et al. Intraoperative radiotherapy for the abdominal lymphatic system in patients with esophageal carcinoma. Dis Esophagus. 1999; 12(4): 270–275. doi: 10.1046/j.1442-2050.1999.00050.x CrossRefGoogle ScholarPubMed