Oesophagus

An endoscope is used to place a suitable catheter through the oesophageal tumour. A high dose iridium source or, less frequently, caesium pellets in the medium dose rate Selectron are introduced into the catheter to treat the tumour. One limitation of brachytherapy is that the tumour can only be treated up to a distance of 1 cm from the source. A major use of intraluminal brachytherapy is as a palliative treatment to relieve either bleeding or dysphagia. Typical results following a single fraction of 15 Gy are improvement in dysphagia in 67% of patients 4–6 weeks after therapy and 47% of patients had complete relief of symptoms.

Intraluminal brachytherapy allows the escalation of dose to the tumour while protecting the surrounding dose limiting structures such as lung, heart and spinal cord. However, the results of clinical trials so far have shown that the addition of brachytherapy as a boost treatment does not appear to have improved results compared with external beam radiotherapy alone or concomitant chemotherapy with radiotherapy.

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