INTRALUMINAL RADIOTHERAPY OF ESOPHAGEAL CANCERS

Between 1993 March - 1997 March 20 cases of esophageal cancer complaining dysphagia due to endoluminal radiotherapy (IRT) by microSelectron HDR machine. Sixteen of the cases were male and 17 of them were diagnosed as epidermoid carcinoma. In the 10 patients treated with curative intent 2 fractions of 5 Gy IRT was given after 60 Gy of external radiotherapy (ERT). Of the patients treated palliatively 6 were treated with 2 fractions of 7.5 Gy IRT alone, 4 were treated with 30 Gy ERT followed by 2 fractions of 5 Gy IRT. The symptomatic response was 75% where in 25% of patients the symptoms completely disappeared. In the curative group symptom free survival of the cases who responded to therapy was 4 to 10 month (median: 6.5 months), in the palliative group it was 2 to 6 months (median 4.5 months). Tumor response was assessed by endoscopy and radiology in the curative group patients and complete response in 2 cases, partial response in 4 patients were determined, thus overall response was 60%. In the curative group survival in 12, 24, and 36 months was 46.6%, 17.5% and 0% respectively (median 12 months) where survival in 6 and 12 months were 40% and 0% in the palliative group (median 5 months). Survival difference was statistically significant between the two groups (p=0.0027). There were serious acute esophagitis in 25%, tracheoesofageal fistula in 10% and esophageal fibrosis requiring dilatation in 5% of patients. It is concluded that IRT is one of the selected treatment methods of the esophageal cancers.