Consultant Dr Alex Stewart, Dr Ajay Mehta in conjunction with Dr Seb Cummins, Dr Marianne Illsley
Oesophageal brachytherapy uses a tube passed into the nose, guided by an endoscope, similar to a feeding NG tube placement to deliver radiotherapy into the gullet (oeophagus). First you will go to the endoscopy suite to have your gastroenterologist or surgeon perform an endoscopy (OGD). They will examine the area that needs to be treated and mark it with small metal clips. They will then place the tube in the area, watching it carefully with the scope. You will then recover from the procedure, with the tube exiting your nose and taped carefully in place. The tube may be a little uncomfortable but not painful.
When you are ready you will transfer to the radiotherapy department to have a CT scan. Following a planning CT scan, a dose of radiation is delivered directly to the oesophagus. The tube is usually removed straight afterwards though occasionally some patients will have a fractionated treatment and stay in overnight with the tube in place and have it removed in the morning after the second brachytherapy treatment. Tube removal is painless and you can go home as soon as you feel ready.
Oesophageal brachytherapy can be used either as a part of curative radiotherapy treatment or for symptom relief of oesophageal cancer. In studies of symptom relief it has been shown to give improvement of swallowing or maintenance of swallowing in the majority of patients. A European randomised trial of oesophageal brachytherapy versus metal stent placement showed that brachytherapy was better than stenting at improving swallowing with improved quality of life and longer duration of improvement in symptoms. Since there is a slight delay in the onset of symptom relief, your doctor will carefully consider your individual symptoms and prognosis when a treatment approach (stenting or brachytherapy) is chosen.