Patient-reported outcomes after external beam radiotherapy versus brachytherapy for palliation of dysphagia in esophageal cancer: A matched comparison of two prospective trials

Abstract

Background and purpose: A matched comparison of external beam radiotherapy (EBRT) versus brachytherapy recently demonstrated that EBRT appears at least as effective for palliating dysphagia in patients with incurable esophageal cancer. The aim of this analysis was to compare patient-reported outcomes (PROs) after EBRT versus brachytherapy. Materials and methods: In a multicenter prospective cohort study, patients with incurable esophageal cancer requiring palliation of dysphagia were included to undergo EBRT (20 Gy in 5 fractions). This EBRT cohort was compared to the single-dose 12 Gy brachytherapy cohort of the previously reported SIRECtrial. Propensity score matching was applied to adjust for baseline imbalances. The primary endpoint of dysphagia improvement was reported previously. PROs were secondary outcomes and assessed at baseline and 3 months after treatment using EORTC QLQ-C30 and QLQ-OES18 questionnaires. Results: A total of 115 enrolled EBRT patients and 93 brachytherapy patients were eligible. After matching, 69 well-balanced pairs remained. At follow-up, significant deteriorations in functioning (i.e. physical, role, social), pain, appetite loss, and trouble with taste were observed after brachytherapy. In the EBRT group, such deterioration was observed only for role functioning, while significant improvements in trouble with eating and pain were found. Between-group comparison showed mostly comparable PRO changes, but significantly favored EBRT with regard to nausea, vomiting, pain, and appetite loss. Conclusion: Short course EBRT results in similar or better PROs at 3 months after treatment compared to single-dose brachytherapy for the palliation of malignant dysphagia. These findings further support its use and inclusion in clinical practice guidelines.

Best Supportive Care of the Patient with Oesophageal Cancer

“…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 ]. Short course palliative RT (20Gy in 5 fractions in consecutive workdays) was better tolerated with equal palliative effects than longer course [ 23 ].…”

Long-term health-related quality of life in patients with advanced esophagogastric cancer receiving first-line systemic therapy

“…The treatment options for dysphagia include stent placement, short-course radiotherapy, or systemic therapy [ 28 ]. If life expectancy is > 3 months, radiotherapy is recommended for palliation of dysphagia [ 29 – 31 ]. In our study, among patients who did not receive radiotherapy or placement of a stent for symptom control, dysphagia, odynophagia, and pain and discomfort improved during first-line therapy, although the improvements were smaller compared to the total population.…”

Palliative radiotherapy and quality of life in patients with locally advanced thoracic esophageal cancer: a single centre experience from Central India

“…physical, role, social), loss of appetite, pain, and altered taste sensation, while those treated with EBRT had deterioration only in role functioning, and had a significant improvement in dysphagia and odynophagia. Comparison of both treatments revealed mostly comparable changes in PRO, but significantly favored EBRT in terms of nausea, vomiting, pain, and appetite loss [16]. In another study, Jeene et al compared the outcome with EBRT (5 fractions of 4 Gy) and intraluminal BT (single dose of 12 Gy).…”

“…Moreover, a study comparing brachytherapy (BT) and external beam radiotherapy (EBRT) reported that EBRT results in a significantly greater proportion of patients with improvement in dysphagia and smaller proportion of patients with severe toxicity [15]. Another study reported that EBRT resulted in significantly favorable outcomes, such as nausea, vomiting, pain, and appetite loss; however, both BT and EBRT resulted in a significantly improved QoL [16].…”