Curative Brachytherapy for Inoperable Early-Stage Oesophageal Cancer: A Case Series and Narrative Review

TL;DR

This study explores combining radiotherapy and brachytherapy to treat early-stage oesophageal cancer in patients who cannot undergo surgery, showing promising survival rates.

Contribution

The study introduces a curative treatment combination for inoperable oesophageal cancer patients with limited options.

Findings

2-year cause-specific survival rate was 79.5% in treated patients.

The treatment showed low severe toxicity with mild side effects like mucositis and ulceration.

Local recurrence-free survival rates remained above 50% at 3 years.

Abstract

Background: A subset of patients with T1-T2 oesophageal cancer are not candidates for surgery or chemotherapy and have a poor prognosis due to limited treatment options. This study evaluated the combination of external beam radiotherapy (EBRT) and endo-oesophageal brachytherapy (EBT) as a curative treatment in these patients, with cause-specific survival (CSS) and local recurrence-free survival (LRFS) as the primary endpoints. Methods: This was a single-centre retrospective analysis of 11 patients with T1-T2 oesophageal cancer treated between 2005 and 2024 with combined EBRT and EBT schedules. Clinical data, treatment schedules, outcomes, and complications were obtained from patient medical records and follow-up documentation. Descriptive statistics and Kaplan–Meier survival analysis were used. Results: The median follow-up was 22 months (2–61 months). CSS rates were 79.5% at 2 years, 66% at 3 years, and 30% at 5 years. LRFS rates were 74.1%, 59%, and 39%, respectively. One severe toxicity (grade ≥ 3) was observed. The most frequent mild toxicities were oesophageal mucositis (18.2%) and ulceration (18.2%). Conclusions: EBT in combination with EBRT seems to be a feasible and well-tolerated treatment with curative intent for inoperable T1-T2 oesophageal cancer patients, offering favourable survival outcomes in a population with limited therapeutic alternatives.

Figures