Oesophageal perforation during neo-adjuvant brachytherapy for oesophageal squamous cell carcinoma

Neo-adjuvant brachytherapy (NBT) for oesophageal cancer is under rapid development in recent years and more reports are required to elucidate its complications and drawbacks. Here, we report a case treated for NBT whose oesophagus was perforated during the procedure and mention necessary precautions to avoid it. A 73 year old male whose upper gastrointestinal endoscopy showed a lesion extending from 29 cm to 33 cm of the incisors with a histology of poorly differentiated squamous cell carcinoma, without metastases. Endoscopic ultrasonography diagnosed a T3 N0 grade tumour. He was selected for NBT and neo-adjuvant chemotherapy. The patient received 5 Gy in the first session of NBT, but in the second session before receiving the same dosage his control chest X-ray showed the tip of the catheter to be out of the oesophageal tract. After confirmation of the perforation by Gastrografin, we performed total oesophagectomy combined with a gastric pull-up procedure. To our best knowledge, our case is the first reported complication related to the direct effect of the catheter and tissue manipulation rather than the radiation beam. Weakness in the oesophageal wall due to tumour involvement makes it prone to perforation by any rigid catheter. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of National Cancer Institute, Cairo University. This is an open access article under the CC BY-NC-ND license