Short-course compared to long-course palliative radiotherapy for oesophageal cancer: a single centre observational cohort study

Abstract

Background Common symptoms of oesophageal cancer are dysphagia, pain, and bleeding. These symptoms can be relieved with palliative radiotherapy. The aim of this study was to analyse the outcome of two different palliative radiotherapy schedules. Methods We conducted a retrospective cohort study on palliative radiotherapy for oesophageal cancer given at Karolinska University Hospital. Patients included were treated with either short-course (20 Gy in 4 Gy fractions daily, 5 consecutive workdays) or long-course (30–39 Gy in 3 Gy fractions, 10–13 consecutive workdays) palliative external beam radiotherapy between January 2009 and December 2013. The primary endpoint was dysphagia relief and secondary endpoints were adverse events, re-interventions, and overall survival. Cox regression analyses were used to estimate the effect of treatment schedule on survival. Results A total of 128 patients received external beam radiotherapy under the study period, of these 75 (58.6%) received short-course radiotherapy and 53 (41.4%) long-course radiotherapy. Sixteen (30.8%) patients experienced dysphagia relief after short-course radiotherapy and 9 (22.0%) patients after long-course radiotherapy (p = 0.341). Acute toxicity was less frequent after short-course radiotherapy than after long-course radiotherapy, particularly oesophagitis (35.4% vs. 56.0%, p = 0.027) and nausea/emesis (18.5% vs. 36.0% p = 0.034). Re-interventions tended to be more common after short-course radiotherapy (32.0%) than after long-course radiotherapy (18.9%) (p = 0.098). There was no difference in overall survival between the two groups. Conclusions Short- and long-course palliative radiotherapy for oesophageal cancer were equally effective to relieve dysphagia and no difference was seen in overall survival. Acute toxicity was, however, more frequent and more severe after long-course radiotherapy. Our results suggest that short-course radiotherapy is better tolerated with equal palliative effects as long-course radiotherapy.

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

“…The recommended dose for palliation is itself a bit variable, with a range of 20 to 40 Gy across the guidelines. 3 , 4 , 5 , 8 , 13 , 14 , 15 , 16 In the current study, 64.8% of the patients who received radiation received less than 45 Gy, 29% received between 45 and 59.9 Gy, and 2.2% received considerably more radiation (60–80 Gy).…”

“…Esophageal stents, cryotherapy, photodynamic therapy, or even cytotoxic chemotherapy may accomplish many of the goals of palliative radiation. 3 , 6 , 7 , 8 , 9 As a result, patient selection must balance possible adverse effects, possible symptomatic improvement, and potential survivorship gains. Better understanding of the current relationship between radiotherapy of the esophagus in newly diagnosed stage IV esophageal cancer and survival may facilitate informed decision making.…”

Comparison between 1-week and 2-week palliative radiotherapy courses for superior vena cava syndrome

“…However, the retreatment rate in the group receiving a single dose of 8 Gy was much higher than that in the 30 Gy in 10 fractions group (28% vs. 2%). Similarly, Olafsdottir et al [21] found that a short course (20 Gy in 5 fractions) for esophageal cancer had a retreatment rate of 32.0% compared with 18.9% for a long course (30 Gy in 10 fractions). Conversely, Rades et al [22] found that a 1-week course (20 Gy in 5 fractions) and a 2-week course (30 Gy in 10 fractions) for metastatic epidural spinal cord compression were similarly effective in motor function, ambulatory rate, and local progression-free survival and maintained effects for up to 6 months.…”

Immunotherapy with or without radiotherapy for metastatic or recurrent esophageal squamous cell carcinoma: A real-world study

“…Natasja’s and Halla’s study revealed that the dysphagia relief rate showed no difference in patients treated with 30–39 Gy in 10–13 fractions and 20 Gy in 5 fractions [22] , [24] . But there was a long time to second intervention and fewer re-interventions in the higher doses group.…”