In this study, we described a clinical case of unoperable squamous carcinoma in the thoracic esophagus, demonstrating the effectiveness of induction chemotherapy followed by independent chemoradiotherapy and brachytherapy in patients with metastatic esophageal carcinoma. The patient was treated with induction chemotherapy, concurrent chemoradiation with weekly carboplatin AUC 2 and paclitaxel 50 mg/m2 and brachytherapy. The most characteristic feature of this clinical case is that the use of brachytherapy in the complex treatment of patients with esophageal carcinoma allows increasing the dose in the target without increasing the risk of complications associated with the escalation of the radiation dose. Brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with external beam radiation therapy. In most patients, esophageal carcinoma is diagnosed at stages III–IV of the disease. Squamous cell esophageal carcinoma is an aggressive disease that, depending on the prevalence, requires various treatment methods, the search for the optimal one is still ongoing. The main standard of treatment in inoperable patients with squamous cell esophageal carcinoma is self — chemoradiotherapy. However, in patients with unoperable esophageal carcinoma, it is also possible to use induction chemotherapy followed by independent chemoradiotherapy and brachytherapy. The combined use of these methods of treatment in conditions of impossibility of surgical intervention is the method of choice in patients with stage III–IV of the disease. The standard dose of DLT for squamous carcinoma of the esophagus is 50.4 Gy. In the conducted studies, it was shown that the escalation of the dose to the tumor using remote radiation therapy leads to an increase in severe post-radiation injuries and an increase in the frequency of deaths. Induction chemotherapy plus concurrent chemoradiotherapy and brachytherapy to boost tumor, and improves disease control and survival.

Background: The incidence of esophageal cancer is increasing. In this connection, the search for the most effective methods of treating this disease continues. In most patients, esophageal cancer is diagnosed at III– IV stages of the disease. Currently, the standard of treatment for inoperable patients is chemo radiotherapy. Brachytherapy is one of the perspective methods of radiation therapy. Using of brachytherapy in the complex treatment of patients with esophageal cancer makes possible to increase the radiation dose without increasing the risk of complications after treatment.Methods: The study included 20 patients with inoperable esophageal cancer (most of them with III stages, 60 %). The age of the patients is from 51 to 89 years, ECOG performance status ½ (25 %/75 %), dysphagia score 1/2/3–4 (25 %,50 %, 25 %). All patients were diagnosed with esophageal squamous cell carcinoma. Most patients were with tumor in the middle third of the esophagus (70 %). The greatest length of the tumor was 10 cm. On the first stage of treatment patients underwent external-beam radiation therapy 46 Gy in 2 Gy fractions with simultaneous chemotherapy. After that, brachytherapy was performed (single dose of 5 Gy, 2 fractions with an interval of 6–7 days, 62,8 Gy (EQD2, α/β = 10 Gy).Results: Patients received therapy support for cardiovascular and lung diseases and nutritional support before, during and following chemoradiotherapy. There were no patients with hematological toxicity grade 3–4. Esophagitis grade 2 was noted in 40 % of patients, grade 1 in 60 % of patients. Esophagitis resolved on its own 2 weeks after completion of therapy. Complete tumor regression was observed in 10 % of patients, partial regression in 80 % of patients, stabilization of tumor process was observed in 10 % of patients. All patients have a poor QOL due to physical and psychological disorders. The general health situation and physical function after 3 months of treatment was improved compared to the prior to treatment period.

Along with surgery and chemotherapy, radiation therapy is the main treatment for malignant tumors. This treatment method is often accompanied by various side effects. They are based on damage to the structure of cells by ionizing radiation. At present, criteria for the assessment of radiation injuries have been developed. One of these injuries is radiation pulmonitis, which can adversely affect the quality of life of patients. Thanks to the introduction into clinical practice of modern methods of radiation therapy, radiation diagnostics and the latest drugs, it became possible to minimize the risk of radiation pulmonitis after treatment.

Introduction: Esophageal cancer (EC) is a malignant disease with low survival rates and limited treatment options in the later stages. The epidemiological situation in developed countries tends to improve. However, in most states, including the Russian Federation, the situation remains in critical condition.Epidemiology of EC: Esophageal cancer is one of the most aggressive malignant disease. According to the International Agency for Research on Cancer (IARC), in 2018, 572 thousand new cases of RP were registered in the world (3.2 % of the total number of malignant disease). In 2018, 508.6 thousand deaths from cancer were recorded in the world (5.3 % of the total number of deaths from cancer, 6th place) [1].EC risk factors: The following factors play an important role in the etiology of squamous EC:1. Diet (nitrites, hot food and drinks, insufficient intake of vitamins and minerals with food).2. Tobacco and alcohol use are independent risk factors, but when combined with others, they increasethe risk of the disease.3. Achalasia of the cardia.4. Burns of the esophagus.5. Autosomal dominant diseases characterized by hyperkeratosis of the palms of the hands and feet.The risk of developing EC reaches 37 % [2].6. Human papillomavirus types 16 and 18 causes a risk of EC in 37 % of patients.Diagnostic methods: Traditional methods for the diagnosis of EC are: esophagogastroduodenosocpy with biopsy, endoscopic ultrasound with puncture biopsy of the mediastinal lymph nodes, computed tomography of the chest and abdominal organs (including contrast), magnetic resonance imaging of the chest cavity (including with contrasting), positron emission tomography with 18F-fluorodeoxyglucose (including combined with computed tomography).