Survival rates of more than 30% at 3 years are currently achievable with a combination of chemotherapy and external beam irradiation in locally advanced esophageal cancer; however, with these regimens, the locoregional recurrence/local progression rates of approximately 40% are still high.
Brachytherapy is one of the most important radiotherapeutic techniques available with the potential for improving durable local control and maintaining the patency of the esophageal lumen permitting adequate swallowing.
The most suitable cases are those with tumors less than 10 cm and with midthoracic location without involvement of peri-esophageal structures such as bronchus, aorta, pericardium, roots of great vessels, and tracheoesophageal fistulas.
The largest clinical experience from an Asian series reports an increase in local control with the addition of brachytherapy.