Main Session
Sep
30
QP 36 - From Brachy to Beams to Biologics: Innovations in Esophageal and Liver Cancer
Presenter(s)
Janmenjoy Mondal, MD, MBA, MBBS - Medical College and Hospital Kolkata, Kolkata, West Benga
J. Mondal1, M. A. Schattner1, H. Gerdes1, A. Markowitz1, M. Nishimura1, S. Maron2, G. Ku1, P. P. McCann3, A. L. Damato3, and A. J. Wu4; 1Memorial Sloan Kettering Cancer Center, New York, NY, 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 3Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 4Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
Purpose/Objective(s):
Local therapy options for esophageal cancer patients declining or ineligible for surgery or additional external beam radiation are limited. Endoluminal high-dose-rate brachytherapy (EHDRBT) can radiate esophageal tumors with minimal dose beyond the esophagus, but is not widely practiced due to the need for specialized expertise and infrastructure, as well as a paucity of data. We characterize our contemporary (within last 20 years) EHDRBT experience with respect to oncologic, toxicity, and symptomatic outcomes.
Materials/Methods:
We retrospectively reviewed 60 patients with esophageal cancer treated with EHDRBT between 2008 and 2025. Applicators that centered the iridium-192 source within the lumen (either solid bougie catheters up to 1.4cm diameter, or inflatable balloon catheters) were used. Median age at treatment was 76; most patients (75%) had adenocarcinoma or squamous cell carcinoma (23%). The majority were treated for recurrent (58%) or persistent disease (23%) after previous external beam chemoradiation and either declined surgery or were considered inoperable. Treatment generally consisted of 5-7 Gy per fraction prescribed to tumor depth, delivered in three sessions once per week. Outcomes evaluated included local response, overall survival (OS), progression-free survival (PFS), dysphagia relief, and treatment-related toxicity.
Results:
Median follow up after EHDRBT was 15 months. For the entire cohort, median OS was 15 months (range 1-91 months) and median PFS was 7.5 months (range 1-83). Of 45 patients (75%) who underwent post-EHDRBT endoscopic biopsy, 18 (40%) had a negative biopsy. Locoregional recurrence or progression was the dominant failure pattern, affecting 63% of patients, while distant relapse occurred in 8%. Of 24 patients with baseline dysphagia, 12 (50%) reported symptomatic improvement after EHDRBT. Acute toxicity included grade =2 dysphagia in 20% of patients and grade =3 dysphagia in 10%; esophagitis of grade =2 and =3 occurred in 10% and 5%, respectively. Serious late events were uncommon, with bleeding in 2% (n=1) and stenosis in 7% (n=4). No treatment-related fistula was observed.
Conclusion:
To our knowledge, this is the largest modern series of esophageal cancer patients treated with endoluminal high dose-rate brachytherapy. A meaningful proportion of patients achieved endoscopic complete response after EHDRBT, but locoregional progression still predominates after treatment. Major toxicity, such as bleeding or fistula, is rare in our experience, likely related to our use of centering applicators and established prescription doses. Patients with malignant dysphagia often experience relief after EHDRBT. Brachytherapy remains a useful modality that can achieve local remission and palliate symptoms in selected esophageal cancer patients.