Evaluation of Complications and Treatment Outcomes Following Intraluminal Brachytherapy after Definitive Chemoradiation in Patients with Esophageal Cancer

Abstract

Background: Limited data exist on complications and treatment outcomes following brachytherapy after chemoradiation in esophageal cancer. This study aimed to assess complications and treatment outcomes after intraluminal brachytherapy post-definitive chemoradiation. Methods and Materials: This retrospective cohort study included esophageal cancer patients treated at Imam Reza Radiotherapy Center, Mashhad, Iran (2016-2023). Patients received chemoradiotherapy with paclitaxel-carboplatin, cisplatin-irinotecan, or cisplatin-5-FU (5-6 weeks), with a total radiation dose of ≥45 Gray. After a two-week rest, they underwent HDR brachytherapy with cobalt-60 and were followed monthly for one year. Results: A total of 125 patients (mean age: 71.08±10.67 years) were evaluated. The overall survival (OS) and disease-free interval (DFI) were 47.26 and 22.62 months, respectively. The most common tumor location was the middle esophagus, and the most common grade was G2. An ECOG score <2 was observed in 96 patients. No significant association was found between OS and DFI with tumor location, grade, dysphagia level, or functional index. However, brachytherapy dose, radiotherapy dose, and chemotherapy regimen were significantly associated with OS, but not with DFI. Post-treatment complications occurred in 98 patients, including local recurrence in 39 cases. Patients without complications had a mean DFI and OS of 54 and 55 months, respectively, while those with complications had 37 and 50 months. Complications were significantly associated with DFI but not with OS. Complete response was seen in 106 patients, significantly correlating with OS (P=0.003) and DFI (P<0.001). Patients with local and distant recurrence had an 11-fold higher mortality risk. Conclusion: Intraluminal brachytherapy after definitive chemoradiation plays a crucial role in treatment management for esophageal cancer. It should be considered as a treatment option, but further studies with larger sample sizes are needed for routine implementation.