Palliative Radiotherapy for Esophageal and Gastric Cancer: Population-Based Patterns of Utilization and Outcomes in Ontario, Canada

Abstract

Objective Patients with incurable esophageal and gastric cancer may develop local symptoms for which palliative radiotherapy (PRT) may be considered. We sought to evaluate patterns in utilization and outcomes of patients receiving PRT for incurable esophageal and gastric cancer in Ontario, Canada using health administrative data. Methods Linked health administrative databases were used to identify patients receiving PRT for incurable esophageal and gastric cancer. Primary outcomes were utilization and delivery of PRT, utilization of endoscopic dilation with or without stent insertion after completion of PRT and survival from 1) date of diagnosis and 2) start of PRT. Results We identified 2500 patients who received PRT. Mean age was 70 ± 13 years and the majority (75%, n = 1873/2500) were male. Over half of the patients had a diagnosis of gastric cancer (58%, n = 1453/2500) and began PRT within 6 months of cancer diagnosis (85%, n = 2125/2500). Of the 2500 patients in the cohort, 2174 patients received EBRT with few receiving brachytherapy ( n = 326) or EBRT and brachytherapy combined ( n = 88). Over the study period, there was an increase in the number of patients receiving PRT (136 in 2007 to 290 in 2016), as well as in the use of advanced conformal radiotherapy techniques. Only 5% (115/2500) required dilation with or without stent insertion after completion of PRT. Median overall and cancer-specific survival of the cohort was 205 days and 209 days from date of diagnosis and 108 days and 110 days from start of PRT. Conclusions PRT is an important treatment for patients with incurable esophageal and gastric cancer who present with local symptoms. Utilization of PRT and advanced EBRT techniques increased over the study period. Few patients require endoscopic dilation with or without stent insertion after completion of PRT suggesting that PRT provides favorable symptom control.

Best Supportive Care of the Patient with Oesophageal Cancer

“…Additionally, it correlates with significantly lower risk of toxicity, better pain control and equivalent relief of moderate to severe dysphagia [ 18 ]. Although intraluminal brachytherapy proved to be effective [ 14 ], it is more invasive and less widely implemented than external beam RT [ 9 , 19 , 20 ], with comparable efficacy [ 21 ]. Furthermore, patient-reported outcomes seem to favour external beam RT [ 22 ].…”

Revalidation of the ATTRACTION-4 study in a real-world setting: a multicenter, retrospective propensity score matching study in China

“…Notably, this population, which was excluded from prospective studies, is worthy of specific attention, and further studies are needed to investigate the efficacy of immunotherapy. Previous studies have confirmed that palliative radiotherapy plays an important role in relieving bleeding, obstruction, and pain and in improving the quality of life of patients with advanced gastric cancer; however, the relationship between palliative radiotherapy and survival is unclear ( 23 – 25 ). A total of 59 patients with advanced gastric cancer who received palliative radiotherapy during the course of the disease were included in this study, and the corresponding results showed that palliative radiotherapy improved their OS.…”