Gastrointestinal brachytherapy: Esophageal cancer

High-dose rate (HDR) endoluminal brachytherapy is a safe, effective and well-tolerated option for the treatment of patients with medically inoperable primary and recurrent esophageal tumors. Optimal endoluminal esophageal HDR technique uses a large diameter applicator that allows delivery of adequate dose at prescription depth while limiting the mucosal dose to tolerable levels. Dose is prescribed to a depth from the surface of the catheter, with prescription depth determined on the basis of clinical assessment of tumor thickness. Maximum tolerated dose is currently being determined in the setting of a phase I clinical trial. Several imaging modalities are employed in treatment planning, delivery, and follow-up of endoluminal brachytherapy including CT, MRI, fluoroscopy, X-ray markers, and endoscopy. An overview of the technical aspects of the procedure as well as issues regarding treatment planning, delivery, and follow-up after endoluminal brachytherapy are discussed in this chapter.