EUS-guided brachytherapy.

摘要

Esophageal cancer has a rising incidence in the United States. Esophageal cancer usually is associated with a poor prognosis, given the high incidence of advanced disease at initial presentation. Currently, surgical resection with neoadjuvant or adjuvant chemoradiotherapy is the treatment of choice for primary esophageal cancers; treatment options are particularly limited for recurrent disease.Brachytherapy, an established therapeutic modality, has been used for many years for various cancers, including head and neck, breast, lung, brain, and, most commonly, prostate cancer. Also, brachytherapy has been shown to have benefit in treating the primary esophageal tumors. In 1994, one study reported that 6 of 8 patients treated with intracavitary brachytherapy had complete regression of the esophageal primary cancer. A potential advantage over the more traditional external-beam radiotherapy (EBRT) was its ability to limit radiation toxicity to the normal tissues surrounding the cancer. Currently, there are no reports of the use of brachytherapy in treating recurrent esophageal cancer limited to periluminal lymph nodes.EUS is highly accurate in the staging of GI cancers, and EUS-guided FNA, with its tissue diagnosis, is more accurate in nodal staging than EUS alone. EUS-guided fine needle injection is a technique with known utility in guiding therapy, as in EUS-guided celiac plexus neurolysis. EUS-guided brachytherapy for the primary tumor has been reported in one small series of patients with head and neck malignancy. We now present a case of EUS-guided brachytherapy in a patient with recurrent esophageal cancer in perigastric lymph nodes.