Reducing dysphagia with palliative 2D high-dose-rate brachytherapy improves survival in esophageal cancer

Abstract

Purpose:The goal of this study was to assess the effectiveness of dysphagia relief and overall survival in patients with advanced esophageal cancer treated with palliative high-dose-rate (HDR) brachytherapy (BT) without computed tomography-based planning.Material and methods: Palliative 2D HDR-BT was used to treat 93 patients with advanced or incurable esophageal cancer in a regional cancer center from October 2010 to December 2016. Before the treatment patients presented the following grades of dysphagia: 0 -0%, I -57%, II -33.3%, III -6.5%, IV -3.2%. The planned dose was 22.5 Gy in 3 fractions. The median age of patients was 65 years (45-88). Squamous cell carcinoma was diagnosed in 59.4%, adenocarcinoma in 22.6%, and other histological types of tumors in 6.7% of cases. The histopathological report was unknown in 11.3% of patients.Results: The mean follow-up was 5.0 months (range 1-43). The median tumor length was 72.5 mm. Due to BT dysphagia was significantly decreased: grade 0 -38.7%, I -31.2%, II -20.4%, IV -1.1% (p < 0.001). Dysphagia relief was achieved in 55% of patients and lasted for a mean time of 4.6 months; stabilization occurred in 31% and deterioration in 14%. The patients with partial or complete dysphagia relief lived longer (5.8 vs. 4.1 months, p = 0.02). The patients with a length of the tumor less than 72.5 mm, histopathologically confirmed adenocarcinoma or after dilatation with a metal stent subsequently to BT had improved overall survival as well (7.1 vs. 3.6; 8.0 vs. 4.1; 6.5 vs. 4.0 months, respectively; p < 0.05). The primary localization and primary grade of dysphagia were not factors that influenced the survival of patients. The logistic regression model did not reveal any predictors for treatment response.Conclusions: 2D HDR-BT reduces dysphagia and prolongs survival in patients who respond to the treatment. It meets the assumption of palliative treatment for advanced esophageal cancer because of its simplicity and effectiveness.

Why is a very easy, useful, old technique underused? An overview of esophageal brachytherapy – interventional radiotherapy

“…Good dysphagia palliation was achieved with an overall survival of 30% at 1-year among responder patients, compared to 10% in those with partial or no response. The results were better for adenocarcinoma types, and 5% of patients remained alive for more than 2 years [ 48 ]. While EBT is an easy technique and is currently recommended by the European Society of Gastrointestinal Endoscopy as a good technique for palliation, it requires infrastructure and experience, which are not available in many centers [ 51 ].…”

“…EBT is a very effective treatment for dysphagia palliation, achieving palliation in 70-90% of the cases, with 50% of complete endoscopic response and a dysphagia-free time usually ranging between 2 and 9 months, depending on the series. In responders, even the simplest 2D HDR-EBT prolongs survival [48]. EBT is also a very useful treatment in patients with a relapse following EBRT [3,[49][50][51].…”

The Role of Brachytherapy Alone and in Combined Treatment of Esophageal Cancer—A Review

“…Intraesophageal brachytherapy has a major role in relieving dysphagia. It results in a reduction in dysphagia in 70-90% of cases and achieves a complete endoscopic response in 50% of cases, which, depending on the study, lasts between 2 and 9 months [53]. Studies indicate that both fractional and total dose should be adjusted according to the patient's general condition and life expectancy, as well as any previously administered dose of external beam irradiation.…”

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“…Уменьшение дисфагии было достигнуто у 55% пациентов и длилось в среднем 4,6 месяца; стабилизация произошла у 31% и ухудшение у 14% пациентов, получавших высокую дозу 2D-брахитерапии [44].…”