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©2013 UpToDate ® Print Email Selection criteria for definitive and palliative brachytherapy for esophageal cancer Definitive treatment Good candidates Unifocal thoracic esophageal cancer ≤10 cm No extraesophageal extension No nodal disease or metastatic disease Poor candidates Tumor >10 cm in length Extraesophageal extension Regional lymphadenopathy Tumor involving GE junction or cardia Contraindications Esophageal fistula Cervical esophageal location Stenosis that cannot be bypassed Palliative treatment Thoracic esophageal lesions with distant metastases Unresectable local disease progression Recurrence after definitive EBRT GE: gastroesophageal; EBRT: external beam radiation therapy. Adapted from Gaspar LE, Nag S, Herskovic A, et al. American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Int J Radiat Oncol Biol Phys 1997; 38:127.

©2013 UpToDate ® Print Email Selection criteria for definitive and palliative brachytherapy for esophageal cancer Definitive treatment Good candidates Unifocal thoracic esophageal cancer ≤10 cm No extraesophageal extension No nodal disease or metastatic disease Poor candidates Tumor >10 cm in length Extraesophageal extension Regional lymphadenopathy Tumor involving GE junction or cardia Contraindications Esophageal fistula Cervical esophageal location Stenosis that cannot be bypassed Palliative treatment Thoracic esophageal lesions with distant metastases Unresectable local disease progression Recurrence after definitive EBRT GE: gastroesophageal; EBRT: external beam radiation therapy. Adapted from Gaspar LE, Nag S, Herskovic A, et al. American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Int J Radiat Oncol Biol Phys 1997; 38:127. Schema for definitive and palliative treatment for esophageal cancer Suggested scheme for definitive treatment External beam radiotherapy (EBRT) 45 to 50 Gy in 1.8 to 2.0 Gy fractions, five times aweek with concurrent chemotherapy followed by brachytherapy Brachytherapy after EBRT and not concurrent with chemotherapy HDR: total dose of 10 Gy, 5 Gy fractions, one fraction per week starting two to three weeks following completion of EBRT LDR: total dose of 20 Gy single course, 0.4 to 1.0 Gy per hour starting two to three weeks after completion of EBRT Suggested scheme for palliative treatment Recurrence after EBRT or short life expectancy Brachytherapy* (HDR: 10 to 14 Gy in one to two fractions or LDR: 20 to 40 Gy in one to two fractions at 0.4 to 1.0 Gy per hour) No previous EBRT EBRT 30 to 40 Gy in two to three Gy fractions followed by brachytherapy* (HDR: 10 to 14 Gy in one to two fractions or LDR: 20 to 25 Gy in a single course at 0.4 to 1.0 Gy per hour) No previous EBRT and life expectancy >6 months Guidelines similar to those for definitive therapy above Gy: gray; HDR: high-dose rate; LDR: low-dose rate. * All brachytherapy doses specified 1 cm from midsource/mid-dwell position. Applicator diameter of 6 to 10 mm is recommended. Adapted from Gaspar LE, Nag S, Herskovic,A, et al. American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Int J Radiat Oncol Biol Phys 1997; 38:127.