Dose Intensified Chemoradiation and Intraluminal Brachytherapy Improve Outcomes in Middle Third Carcinoma Esophagus: Experience from a Regional Cancer Center

Abstract

Introduction Esophageal cancer is known for its poor outcome despite multimodality treatment. In this study, we report our experience with concurrent capecitabine-based chemoradiotherapy followed by intraluminal brachytherapy (ILBT) for middle third esophageal cancer. Materials and Methods Twenty patients of histology-proven middle third esophageal cancer were treated with 45 Gray (Gy)/25 fraction (fr) of external beam radiation on telecobalt using two-dimensional technique with concurrent cisplatin 40 mg/m2 weekly with five such cycles along with tablet capecitabine 825 mg/m2 twice daily for the first 2 weeks and last 2 weeks of radiotherapy. This was followed by ILBT of 4 Gy × 3 fr placed 1 week apart from a total biologically effective dose of 60 Gy. Patients were followed up with clinical examination and serial barium swallow to assess response and toxicity. Results Out of 20 patients, disease-free survival at 2 years was 60%. At 5 years, the actuarial survival was 47% with five patients alive and two patients lost to follow-up at 3 years. One patient had grade 3 toxicity in the form of tracheoesophageal fistula (5%). Two patients had distal failure. Two patients had second primary tumor in the upper aerodigestive tract at the end of 7 years. Conclusion A combination of chemotherapy with cisplatin and capecitabine given concurrently with radical radiation therapy followed by ILBT boost is a safe and feasible protocol in the treatment of carcinoma esophagus involving middle third of esophagus. The local control and survival are comparable to historical studies with minimal toxicity.

Keywords

• capecitabine
• carcinoma esophagus
• intraluminal brachytherapy