| Summary: | Oesophageal cancer is the most common cancer amongst black South African
men. More than 95% of the cases are diagnosed at a stage where treatment
options are essentially palliative. Treatment options include bypass surgery, laser
therapy, intubation, external beam radiotherapy, chemotherapy and a
combination of these. The prognosis is dismal. The median survival regardless of
the method is less than 5 months. Most methods are expensive, and utilise
in-patient and hospital resources often for prolonged periods of time. These are
also associated with morbidity and mortality of the procedure. Brachytherapy has
been reported to be an effective means of palliating oesophageal cancer in
patients who have not responded successfully to other means of therapy. It is
relatively safe, cost effective and can be done on an out patient basis thus
allowing for optimal utilisation of resources.
Unfortunately, there a.e no randomised prospective studies in the literature on
the use of brachytherapy alone in oesophageal cancer. Further, there is no
consensus on the "most effective" brachytherapy dose, as most studies are
retrospectively reported, and are usually conducted on small numbers of
patients. Often the results lack patient details, and are based on patients who
have failed other methods of therapy.
This report looks at the results of brachytherapy when used alone in the
palliation of advanced oesophageal cancer, and further examines :
1. The question of dose optimisation in a randomised prospective setting
2. The role of teletherapy and teletherapy combined with brachytherapy
boost in the palliation of oesophageal cancer in a randomised
prospective trial.
3. The role of high dose fraction teletherapy in opening an occluded
oesophageal lumen in patients, in whom initial brachytherapy is not
possible due to tight strictures, and/or long lesions.
4. The role of chemosensitisation with brachytherapy in palliation of
advanced oesophageal cancer in a randomised prospective study.
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