Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review

Murray, Louise; Din, Omar; Kumar, V.; Dixon, Lynne; Wadsley, Jonathan

doi:10.1016/j.prro.2011.12.002

Cited by 34 publications

(31 citation statements)

References 40 publications

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“…Murray et al performed a retrospective study, which shares important similarities with ours 18 . They analyzed data from 148 patients with histologically proven esophageal cancer, who were unsuitable for radical treatment (2005-2010).…”

Section: Discussionsupporting

confidence: 58%

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Welsch¹,

Kup²,

Nieder³

et al. 2016

J. Cancer

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Purpose: The aim of this study was to assess the 6-months dysphagia-free survival, improvement in swallowing function, complication rate, and overall survival in patients with incurable esophageal cancer treated with palliative radiotherapy.Methods: We retrospectively reviewed data from 139 patients (median age 72 years) with advanced/recurrent incurable esophageal cancer, who were referred to 3 German radiation oncology centers for palliative radiotherapy between 1994 and 2014. Radiotherapy consisted of external beam radiotherapy (EBRT) with 30 - 40.5 Gy/2.5 - 3 Gy per fraction, brachytherapy alone (BT) with 15 - 25 Gy/5 - 7Gy per fraction/weekly and EBRT + BT (30 - 40.5 Gy plus 10 - 14 Gy with BT) in 65, 46, and 28 patients, respectively. Dysphagia-free survival (Dy-PFS) was defined as the time to worsening of dysphagia for at least one point, a new loco-regional failure or death of any cause.Results: Median follow-up time was 6 months (range 1-6 months). Subjective symptom relief was achieved in 72 % of patients with median response duration of 5 months. The 1-year survival rate was 30%. The 6-months Dy-PFS time for the whole group was 73 ± 4%. The 6-months Dy-PFS was 90 ± 4% after EBRT, 92 ± 5% after EBRT + BT and 37 ± 7% after BT, respectively (p<0.001). Five patients lived for more than 2 years, all of them were treated with EBRT ± BT. Ulceration, fistula and stricture developed in 3, 6 and 7 patients, respectively.Conclusions: Radiotherapy leads to symptom improvement in the majority of patients with advanced incurable esophageal cancer. The present results favor EBRT ± BT over BT alone. Due to the retrospective nature of this study, imbalances in baseline characteristics might have contributed to this finding, and further trials appear necessary.

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Section: Discussionsupporting

confidence: 58%

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Welsch¹,

Kup²,

Nieder³

et al. 2016

J. Cancer

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“…The radiotherapy schedule used in this trial with 20 Gy in five fractions has to the best of our knowledge not previously been evaluated in a prospective trial. In a retrospective study [23] on 148 patients with esophageal cancer (70% adenocarcinoma) 89% of the patients received 20 Gy in five fractions and the rate of dysphagia improvement was 75%. In a recent retrospective study [24], on 205 patients treated with palliative radiotherapy, three different fractionation schedules were compared: 20 Gy in five fractions; 30 Gy in 10 fractions and 39 Gy in 13 fractions, with improvement of dysphagia in 48%, 40% and 35% of the patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

Palliative short-course hypofractionated radiotherapy followed by chemotherapy in esophageal adenocarcinoma: the phase II PALAESTRA trial

et al. 2019

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Background: The majority of patients with incurable esophageal adenocarcinoma suffer from dysphagia. We assessed a novel treatment strategy with initial short-course radiotherapy followed by chemotherapy with the primary aim to achieve long-term relief of dysphagia. Methods: This phase II trial included treatment-naîve patients with dysphagia due to esophageal adenocarcinoma not eligible for curative treatment. External beam radiotherapy with 20 Gy in five fractions to the primary tumor was followed by four cycles of chemotherapy (FOLFOX regimen). Dysphagia was assessed using a five-grade scale. Results: From October 2014 to May 2018 a total of 29 patients were enrolled. The rate of dysphagia improvement was 79%, median duration of improvement 6.7 months (12.2 months for responders) and median overall survival 9.9 months. In the pre-specified per protocol analysis (23 patients) the rate of dysphagia improvement was 91%, median duration of improvement 12.2 months (14.0 months for responders) and median overall survival 16.0 months. The most common grade 3-4 adverse events were neutropenia (29%), infection (25%), anorexia (11%), esophagitis (11%) and fatigue (11%). Conclusion: Initial palliative short-course radiotherapy followed by chemotherapy is a promising treatment strategy that can provide long-lasting relief of dysphagia in patients with esophageal adenocarcinoma.

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“…Effective palliation of dysphagia is the primary goal of treatment to ensure adequate quality of remaining life. Various modalities have been used for palliation of dysphagia like bypass surgery [ 4 ], laser [ 5 ], photodynamic therapy [ 6 ], stent placement [ 7 ], chemotherapy [ 8 ], external beam radiotherapy (EBRT) [ 9 ], intraluminal brachytherapy (ILBT) [ 10 , 11 ], and chemoradiation [ 12 ]. External beam radiotherapy alone or in combination with ILBT, or ILBT alone have all been tried.…”

Section: Purposementioning

confidence: 99%

Combined brachytherapy and external beam radiation: an effective approach for palliation in esophageal cancer

Laskar¹,

Lewis²,

Agarwal³

et al. 2015

jcb

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PurposePalliation of dysphagia is a challenge in advanced esophageal cancer. The addition of external beam radiotherapy (EBRT) to intraluminal brachytherapy (ILBT) has shown significant improvement in dysphagia relief and symptom scores. The aim of the present study was to evaluate the efficacy of combined use of ILBT and EBRT.Material and methodsThe medical records of 148 patients with advanced/metastatic esophageal cancer were screened from January 2008 to April 2014, and 74 patients were found eligible for the analysis. All patients received two fractions of 8 Gy each of ILBT, followed by EBRT. Patients were assessed for the symptom scores of dysphagia, odynophagia, regurgitation, and chest pain and weight was recorded periodically.ResultsFor a median follow-up of 6 months, the median OS was 9.5 months (95% CI: 7.5-10.5). The median dysphagia free survival was 6 months (95% CI: 4.8-7.1). The scores for dysphagia significantly improved after completion of 1st ILBT (p = 0.000), 2nd ILBT (p = 0.000), and at 3 months after EBRT compared to ILBT (p = 0.02). Overall 47% had improvement in dysphagia scores and 35% maintained the improvement of scores till last follow up. There was significant improvement in weight after completion of ILBT (p = 0.001) and at 3 months after completion of EBRT (p = 0.00). Twenty nine (39%) patients required nasogastric (NGT) insertions and 12 (16%) needed hospitalization for supportive care. 36.4% had complications in the form of stricture (27%), fistula (5.4%), and bleeding (4%).ConclusionsPalliative radiotherapy is an effective alternative for palliation of dysphagia with improvement in symptom scores being evident and sustained. The results of this clinical audit were comparable with those from the trial setting.

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Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review

Cited by 34 publications

References 40 publications

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Palliative short-course hypofractionated radiotherapy followed by chemotherapy in esophageal adenocarcinoma: the phase II PALAESTRA trial

Combined brachytherapy and external beam radiation: an effective approach for palliation in esophageal cancer

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