Judith Martland
Northern Sydney Cancer Centre
Senior Physicist

Florence Ko
Radiation Therapist
Northern Sydney Cancer Centre

George Hruby
Radiation Oncologist
Northern Sydney Cancer Centre

Andrew Kneebone
Radiation Oncologist
Northern Sydney Cancer Centre

Background and Purpose

A 69 year old patient with oesophageal carcinoma presented for palliative radiotherapy, however due to very significant cerebral palsy resulting in severe scoliosis and contracture of limbs it was realised that stable immobilisation for external beam radiotherapy would be impossible. The patient was therefore considered for brachytherapy.

Methods

A dose prescription of 2400 cGy in 4 fractions over one week was prescribed, to a treatment distance of 1cm and a length of 5cm. A 5 french flexible catheter (Nucletron LumencathTM) with a marker wire in place was inserted into a nasogastric tube in-situ and passed beyond the tumour at the cardio-oesophageal junction. The patient was then CT imaged and a 3D reconstruction and patient plan produced. The brachytherapy treatment was delivered as planned, with the patient able to return to her care home shortly afterwards.

Results

The patient’s severely irregular anatomy and tortuous distal oesophagus made the planning process challenging, and reflux of gastric fluid through the nasogastric tube made catheter fixation difficult. The brachytherapy was nevertheless successfully delivered and at follow up seven months later the patient was well with no symptoms suggestive of recurrence and no evidence of radiation toxicity.

Conclusions

For this patient, brachytherapy provided an excellent treatment approach, enabling accurate 3D planning and treatment despite the patient’s pre-existing condition precluding immobilisation.


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