Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials

Abstract

Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies. Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score-matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicity and time-to-effect. Results: A total of 115 patients treated with EBRT and 93 patients who underwent brachytherapy were eligible for analysis. In the original cohorts, dysphagia improved after EBRT in 79% of patients compared with 64% after brachytherapy (p ¼ 0.058). Propensity score matching resulted in 69 patients in each cohort well-balanced at baseline. Improvement of dysphagia was observed in 83% after EBRT versus 64% after brachytherapy (p ¼ 0.048). In responding patients, improvement of dysphagia at 2 weeks was observed in 67% after EBRT compared with 35% after brachytherapy, and the maximum effect was reached after 4 weeks in 55% and 33%, respectively. Severe toxicity

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

“…As described in the previous report on the efficacy and safety endpoints [13], propensity score matching was applied to adjust for imbalances in baseline characteristics between the two groups. A logistic regression model was performed to determine a propen-sity score for each patient in which the variables age, sex, WHO performance score !2, previous chemotherapy, tumor histology, tumor location, tumor length, and reason for palliation (i.e.…”

“…The planning technique was either 3D-conformal radiotherapy or intensity-modulated radiotherapy (IMRT). Details on definitions of the target volumes, organ-at-risk dose constraints, and position verification protocols were reported previously [13]. Intraluminal brachytherapy was performed by passing a flexible applicator with a diameter of 10 mm down the esophagus.…”

“…In fact, short course EBRT has been the most commonly applied treatment strategy in the Netherlands and other countries, possibly because it offers substantial logistical advantages [12]. Our recent 'Palliation of Obstructive Local Disease of the Esophagus by Radiotherapy' (POLDER) study comparing EBRT with brachytherapy using data from a contemporary prospective EBRT cohort and the brachytherapy-arm of the SIREC study was the first study to present prospective data on EBRT in this setting [13]. The 1:1 propensity score-matched analysis in 138 patients demonstrated that EBRT was at least as effective as brachytherapy with regard to the primary outcome measure of dysphagia improvement (83% after EBRT versus 64% after brachytherapy, p = 0.048) [13].…”

“…Our recent 'Palliation of Obstructive Local Disease of the Esophagus by Radiotherapy' (POLDER) study comparing EBRT with brachytherapy using data from a contemporary prospective EBRT cohort and the brachytherapy-arm of the SIREC study was the first study to present prospective data on EBRT in this setting [13]. The 1:1 propensity score-matched analysis in 138 patients demonstrated that EBRT was at least as effective as brachytherapy with regard to the primary outcome measure of dysphagia improvement (83% after EBRT versus 64% after brachytherapy, p = 0.048) [13]. Also, severe toxicity was less and overall survival was not compromised after EBRT compared to brachytherapy [13].…”

“…The 1:1 propensity score-matched analysis in 138 patients demonstrated that EBRT was at least as effective as brachytherapy with regard to the primary outcome measure of dysphagia improvement (83% after EBRT versus 64% after brachytherapy, p = 0.048) [13]. Also, severe toxicity was less and overall survival was not compromised after EBRT compared to brachytherapy [13].…”