The role of brachytherapy alone and in conjunction with teletherapy or chemotherapy in advanced oesophageal carcinoma

Abstract

Oesophageal cancer is the most common cancer amongst black South African men. More than 95% of the cases are diagnosed at a stage where treatment options are essentially palliative. Treatment options include bypass surgery, laser therapy, intubation, external beam radiotherapy, chemotherapy and a combination of these. The prognosis is dismal. The median survival regardless of the method is less than 5 months. Most methods are expensive, and utilise in-patient and hospital resources often for prolonged periods of time. These are also associated with morbidity and mortality of the procedure. Brachytherapy has been reported to be an effective means of palliating oesophageal cancer in patients who have not responded successfully to other means of therapy. It is relatively safe, cost effective and can be done on an out patient basis thus allowing for optimal utilisation of resources. Unfortunately, there a.e no randomised prospective studies in the literature on the use of brachytherapy alone in oesophageal cancer. Further, there is no consensus on the "most effective" brachytherapy dose, as most studies are retrospectively reported, and are usually conducted on small numbers of patients. Often the results lack patient details, and are based on patients who have failed other methods of therapy. This report looks at the results of brachytherapy when used alone in the palliation of advanced oesophageal cancer, and further examines : 1. The question of dose optimisation in a randomised prospective setting 2. The role of teletherapy and teletherapy combined with brachytherapy boost in the palliation of oesophageal cancer in a randomised prospective trial. 3. The role of high dose fraction teletherapy in opening an occluded oesophageal lumen in patients, in whom initial brachytherapy is not possible due to tight strictures, and/or long lesions. 4. The role of chemosensitisation with brachytherapy in palliation of advanced oesophageal cancer in a randomised prospective study.