Hdr Brachytherapy In Advanced Esophageal Cancer: Analysis Of The Palliation Of Dysphagia In 108 Patients.

e14599 Background: Most of the esophageal cancer patients are inoperable at presentation. Dysphagia is one of the main symptoms and patient’s quality of life is an important aspect of the treatment. The purpose of this retrospective study was to estimate the improvement in the palliation of dysphagia and the complication rate of the HDR brachytherapy. Methods: In the period between August 1997 and July 2008, 108 patients with advanced esophageal cancer, were submitted to 3 sessions of HDR brachytherapy, 5Gy each. Patients with cervical esophagus were also subjected to brachytherapy.Patients with tracheoesophagicfistula visible through the bronchoscopy were considered ineligible. Dysphagia was divided in 4 grades: absent (0), solid (1), semisolids (2), liquid (3). The improvement was measured in a scale of points;1 point corresponding to an improvement in 1 grade of dysfaghia and 2 or 3 points corresponding to an improvement of 2 or 3 grades. Results: After 8 weeks after brachytherapy, dysphagia was relieved in 36 % of the patients, remained stable in 42% and worsened in 22% of the cases. An improvement of 1 point was observed in 21% patients, with an improvement of 2 and 3 points in 10.5% and 4.7 % of patients respectively. Complete response was observed in 21.2%, greater than 50% response in 18.5%, less than 50% response in 12% and disease progression in 47.2% of the patients, assessed by endoscopy. Stenosis was observed in 39.8 % of patients, with 6.5% presenting bleeding, and 7.4% presenting fistula. Esophageal dilatation was performed in 29 % of the cases and prosthesis was implanted in 11.5 %. An analysis comparing the complication rate with the location of the tumor (upper, middle and lower esophagus) showed the presence of stenosis in 46.1%, 37.8% and 42.8% of the patients; bleeding in 15.3%, 4% and 9.5%; and late fistula in 0%, 9.4% and 4.7% respectively. Conclusions: In patients with esophageal advanced disease treated at a major center of a developing country, it was demonstrated that brachytherapy is an effective treatment for the palliation of malignant dysphagia. Brachytherapy in upper esophagus is a feasible treatment, since it showed equivalent complication rate compared to middle and lower locations.